1
|
Faust PL, McCreary M, Musacchio JB, Kuo SH, Vonsattel JPG, Louis ED. Pathologically based criteria to distinguish essential tremor from controls: analyses of the human cerebellum. Ann Clin Transl Neurol 2024. [PMID: 38644741 DOI: 10.1002/acn3.52068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/02/2024] [Indexed: 04/23/2024] Open
Abstract
OBJECTIVE Essential tremor is among the most prevalent neurological diseases. Diagnosis is based entirely on neurological evaluation. Historically, there were few postmortem brain studies, hindering attempts to develop pathologically based criteria to distinguish essential tremor from control brains. However, an intensive effort to bank essential tremor brains over recent years has resulted in postmortem studies involving >200 brains, which have identified numerous degenerative changes in the essential tremor cerebellar cortex. Although essential tremor and controls have been compared with respect to individual metrics of pathology, there has been no overarching analysis to derive a combination of metrics to distinguish essential tremor from controls. We asked whether there is a constellation of pathological findings that separates essential tremor from controls, and how well that constellation performs. METHODS Analyses included 100 essential tremor brains from the essential tremor centralized brain repository and 50 control brains. A standard tissue block from the cerebellar cortex was used to quantify 11 metrics of pathological change. Three supervised classification algorithms were investigated, with data divided into training and validation samples. RESULTS Using three different algorithms, we illustrate the ability to correctly predict a diagnosis of essential tremor, with sensitivity and specificity >87%, and in the majority of situations, >90%. We also provide a web-based application that uses these metric values, and based on specified cutoffs, determines the likely diagnosis. INTERPRETATION These analyses set the stage for use of pathologically based criteria to distinguish clinically diagnosed essential tremor cases from controls, at the time of postmortem.
Collapse
Affiliation(s)
- Phyllis L Faust
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Morgan McCreary
- Statistical Planning and Analysis Section, Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
| | - Jessica B Musacchio
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Sheng-Han Kuo
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Jean-Paul G Vonsattel
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, New York, USA
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, New York, USA
| | - Elan D Louis
- Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
| |
Collapse
|
2
|
Lin CYR, Kuo SH, Opal P. Cognitive, Emotional, and Other Non-motor Symptoms of Spinocerebellar Ataxias. Curr Neurol Neurosci Rep 2024; 24:47-54. [PMID: 38270820 PMCID: PMC10922758 DOI: 10.1007/s11910-024-01331-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE OF REVIEW Spinocerebellar ataxias (SCAs) are autosomal dominant degenerative syndromes that present with ataxia and brain stem abnormalities. This review describes the cognitive and behavioral symptoms of SCAs in the context of recent knowledge of the role of the cerebellum in higher intellectual function. RECENT FINDINGS Recent studies suggest that patients with spinocerebellar ataxia can display cognitive deficits even early in the disease. These have been given the term cerebellar cognitive affective syndrome (CCAS). CCAS can be tracked using newly developed rating scales. In addition, patients with spinocerebellar ataxia also display impulsive and compulsive behavior, depression, anxiety, fatigue, and sleep disturbances. This review stresses the importance of recognizing non-motor symptoms in SCAs. There is a pressing need for novel therapeutic interventions to address these symptoms given their deleterious impact on patients' quality of life.
Collapse
Affiliation(s)
- Chi-Ying R Lin
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Sheng-Han Kuo
- Department of Neurology and Initiative for Columbia Ataxia and Tremor, Columbia University Irving Medical Center, New York, NY, USA
| | - Puneet Opal
- Davee Department of Neurology and Department of Cell and Developmental Biology, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL, 60611, USA.
| |
Collapse
|
3
|
Lai RY, Rummey C, Amlang CJ, Lin CYR, Chen TX, Perlman S, Wilmot G, Gomez CM, Schmahmann JD, Paulson H, Ying SH, Onyike CU, Zesiewicz TA, Bushara KO, Geschwind MD, Figueroa KP, Pulst SM, Subramony SH, Burns MR, Opal P, Duquette A, Ashizawa T, Hamedani AG, Davis MY, Srinivasan SR, Moore LR, Shakkottai VG, Rosenthal LS, Kuo SH. Fatigue Impacts Quality of Life in People with Spinocerebellar Ataxias. Mov Disord Clin Pract 2024. [PMID: 38419568 DOI: 10.1002/mdc3.14006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/21/2023] [Accepted: 01/26/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Fatigue is a prevalent and debilitating symptom in neurological disorders, including spinocerebellar ataxias (SCAs). However, the risk factors of fatigue in the SCAs as well as its impact have not been well investigated. OBJECTIVES To study the prevalence of fatigue in SCAs, the factors contributing to fatigue, and the influence of fatigue on quality of life. METHODS Fatigue was assessed in 418 participants with SCA1, SCA2, SCA3, and SCA6 from the Clinical Research Consortium for the Study of Cerebellar Ataxia using the Fatigue Severity Scale. We conducted multi-variable linear regression models to examine the factors contributing to fatigue as well as the association between fatigue and quality of life. RESULTS Fatigue was most prevalent in SCA3 (52.6%), followed by SCA1 (36.7%), SCA6 (35.7%), and SCA2 (35.6%). SCA cases with fatigue had more severe ataxia and worse depressive symptoms. In SCA3, those with fatigue had a longer disease duration and longer pathological CAG repeat numbers. In multi-variable models, depressive symptoms, but not ataxia severity, were associated with more severe fatigue. Fatigue, independent of ataxia and depression, contributed to worse quality of life in SCA3 and SCA6 at baseline, and fatigue continued affecting quality of life throughout the disease course in all types of SCA. CONCLUSIONS Fatigue is a common symptom in SCAs and is closely related to depression. Fatigue significantly impacts patients' quality of life. Therefore, screening for fatigue should be considered a part of standard clinical care for SCAs.
Collapse
Affiliation(s)
- Ruo-Yah Lai
- Department of Neurology, Columbia University Medical Center, New York, New York, USA
- Initiative of Columbia Ataxia and Tremor, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Christian J Amlang
- Department of Neurology, Columbia University Medical Center, New York, New York, USA
- Initiative of Columbia Ataxia and Tremor, Columbia University Irving Medical Center, New York, New York, USA
- Department of Neurology, SUNY Downstate Health Sciences University, Brooklyn, New York, New York, USA
| | - Chi-Ying R Lin
- Alzheimer's Disease and Parkinson's Disease Centers, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Tiffany X Chen
- Department of Neurology, Columbia University Medical Center, New York, New York, USA
- Initiative of Columbia Ataxia and Tremor, Columbia University Irving Medical Center, New York, New York, USA
- Department of Biomedical Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Susan Perlman
- Department of Neurology, University of California Los Angeles, Los Angeles, California, USA
| | - George Wilmot
- Department of Neurology, Emory University, Atlanta, Georgia, USA
| | | | - Jeremy D Schmahmann
- Ataxia Center, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Henry Paulson
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sarah H Ying
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Chiadi U Onyike
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Khalaf O Bushara
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael D Geschwind
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Karla P Figueroa
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Stefan M Pulst
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Sub H Subramony
- Department of Neurology, McKnight Brain Institute, University of Florida, Gainesville, Florida, USA
| | - Matthew R Burns
- Department of Neurology, McKnight Brain Institute, University of Florida, Gainesville, Florida, USA
| | - Puneet Opal
- Department of Neurology, Northwestern University, Chicago, Illinois, USA
| | - Antoine Duquette
- Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada
| | | | - Ali G Hamedani
- Departments of Neurology, Ophthalmology, and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marie Y Davis
- Department of Neurology, University of Washington, Seattle, Washington, USA
- Neurology Division, VA Puget Sound Health Care System, Seattle, WA, United States
| | | | | | - Vikram G Shakkottai
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Liana S Rosenthal
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University Medical Center, New York, New York, USA
- Initiative of Columbia Ataxia and Tremor, Columbia University Irving Medical Center, New York, New York, USA
| |
Collapse
|
4
|
Chen TX, Casey HL, Lin CYR, Boyle TA, Schmahmann JD, L'Italien GJ, Kuo SH, Gomez CM. Early-Life Social Determinants of SCA6 Age at Onset, Severity, and Progression. Cerebellum 2024:10.1007/s12311-023-01655-w. [PMID: 38217689 DOI: 10.1007/s12311-023-01655-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/23/2023] [Indexed: 01/15/2024]
Abstract
SCA6 patients with the same size CAG repeat allele can vary significantly in age at onset (AAO) and clinical progression. The specific external factors affecting SCA6 have yet to be investigated. We assessed the effect of early life events on AAO, severity, and progression in SCA6 patients using a social determinant of health approach. We performed a survey of biological and social factors in SCA6 patients enrolled in the SCA6 Network at the University of Chicago. AAO of ataxia symptoms and patient-reported outcome measure (PROM) of ataxia were used as primary outcome measures. Least absolute shrinkage and selection operation (LASSO) regressions were used to identify which early life factors are predictive of SCA6 AAO, severity, and progression. Multiple linear regression models were then used to assess the degree to which these determinants influence SCA6 health outcomes. A total of 105 participants with genetically confirmed SCA6 completed the assessments. SCA6 participants with maternal difficulty during pregnancy, active participation in school sports, and/or longer CAG repeats were determined to have earlier AAO. We found a 13.44-year earlier AAO for those with maternal difficulty in pregnancy than those without (p = 0.008) and a 12.31-year earlier AAO for those active in school sports than those who were not (p < 0.001). Higher education attainment was associated with decreased SCA6 severity and slower progression. Early life biological and social factors can have a strong influence on the SCA6 disease course, indicating that non-genetic factors can contribute significantly to SCA6 health outcomes.
Collapse
Affiliation(s)
- Tiffany X Chen
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
- Initiative of Columbia Ataxia and Tremor, Columbia University Medical Center, New York, NY, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Hannah L Casey
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Chi-Ying R Lin
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Theresa A Boyle
- Department of Pathology and Cell Biology, University of South Florida, Tampa, FL, USA
| | - Jeremy D Schmahmann
- Department of Neurology, Massachusetts General Hospital, Ataxia Unit, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Harvard Medical School, Boston, MA, USA
| | - Gilbert J L'Italien
- Global Health Outcomes and Epidemiology, Biohaven Pharmaceuticals, New Haven, CT, USA
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University Medical Center, New York, NY, USA.
- Initiative of Columbia Ataxia and Tremor, Columbia University Medical Center, New York, NY, USA.
| | | |
Collapse
|
5
|
Currò R, Dominik N, Facchini S, Vegezzi E, Sullivan R, Galassi Deforie V, Fernández-Eulate G, Traschütz A, Rossi S, Garibaldi M, Kwarciany M, Taroni F, Brusco A, Good JM, Cavalcanti F, Hammans S, Ravenscroft G, Roxburgh RH, Parolin Schnekenberg R, Rugginini B, Abati E, Manini A, Quartesan I, Ghia A, Lòpez de Munaìn A, Manganelli F, Kennerson M, Santorelli FM, Infante J, Marques W, Jokela M, Murphy SM, Mandich P, Fabrizi GM, Briani C, Gosal D, Pareyson D, Ferrari A, Prados F, Yousry T, Khurana V, Kuo SH, Miller J, Troakes C, Jaunmuktane Z, Giunti P, Hartmann A, Basak N, Synofzik M, Stojkovic T, Hadjivassiliou M, Reilly MM, Houlden H, Cortese A. Role of the repeat expansion size in predicting age of onset and severity in RFC1 disease. Brain 2024:awad436. [PMID: 38193360 DOI: 10.1093/brain/awad436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/04/2023] [Accepted: 12/10/2023] [Indexed: 01/10/2024] Open
Abstract
RFC1 disease, caused by biallelic repeat expansion in RFC1, is clinically heterogeneous in terms of age of onset, disease progression and phenotype. We investigated the role of the repeat size in influencing clinical variables in RFC1 disease. We also assessed the presence and role of meiotic and somatic instability of the repeat. In this study, we identified 553 patients carrying biallelic RFC1 expansions and measured the repeat expansion size in 392 cases. Pearson's coefficient was calculated to assess the correlation between the repeat size and age at disease onset. A Cox model with robust cluster standard errors was adopted to describe the effect of repeat size on age at disease onset, on age at onset of each individual symptoms, and on disease progression. A quasi-poisson regression model was used to analyse the relationship between phenotype and repeat size. We performed multi-variate linear regression to assess the association of the repeat size with the degree of cerebellar atrophy. Meiotic stability was assessed by Southern blotting on first-degree relatives of 27 probands. Finally, somatic instability was investigated by optical genome mapping on cerebellar and frontal cortex and unaffected peripheral tissue from four post-mortem cases. A larger repeat size of both smaller and larger allele was associated with an earlier age at neurological onset (smaller allele HR = 2.06, p < 0.001; larger allele HR = 1.53, p < 0.001) and with a higher hazard of developing disabling symptoms, such as dysarthria or dysphagia (smaller allele HR = 3.40, p < 0.001; larger allele HR = 1.71, p = 0.002) or loss of independent walking (smaller allele HR = 2.78, p < 0.001; larger allele HR = 1.60; p < 0.001) earlier in disease course. Patients with more complex phenotypes carried larger expansions (smaller allele: complex neuropathy RR = 1.30, p = 0.003; CANVAS RR = 1.34, p < 0.001; larger allele: complex neuropathy RR = 1.33, p = 0.008; CANVAS RR = 1.31, p = 0.009). Furthermore, larger repeat expansions in the smaller allele were associated with more pronounced cerebellar vermis atrophy (lobules I-V β=-1.06, p < 0.001; lobules VI-VII β=-0.34, p = 0.005). The repeat did not show significant instability during vertical transmission and across different tissues and brain regions. RFC1 repeat size, particularly of the smaller allele, is one of the determinants of variability in RFC1 disease and represents a key prognostic factor to predict disease onset, phenotype, and severity. Assessing the repeat size is warranted as part of the diagnostic test for RFC1 expansion.
Collapse
Affiliation(s)
- Riccardo Currò
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Natalia Dominik
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Stefano Facchini
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Elisa Vegezzi
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Roisin Sullivan
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | | | - Gorka Fernández-Eulate
- Nord/Est/Ile-de-France Neuromuscular Reference Center, Institute of Myology, Pitié-Salpêtrière Hospital, APHP, 75013 Paris, France
| | - Andreas Traschütz
- Research Division "Translational Genomics of Neurodegenerative Diseases", Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, 72076 Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, 72076 Tübingen, Germany
| | - Salvatore Rossi
- Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Facoltà di Medicina e Chirurgia, L. F. Vito 1, 00168 Rome, Italy
| | - Matteo Garibaldi
- Neuromuscular and Rare Disease Center, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sant'Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Mariusz Kwarciany
- Department of Adult Neurology, Medical University of Gdańsk, 80-952 Gdańsk, Poland
| | - Franco Taroni
- Fondazione IRCCS Istituto Neurologico Carlo Besta, 20126 Milan, Italy
| | - Alfredo Brusco
- Department of Medical Sciences, University of Torino, 10124 Turin, Italy
| | - Jean-Marc Good
- Division of Genetic Medicine, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
| | - Francesca Cavalcanti
- Institute for Biomedical Research and Innovation (IRIB), Italian National Research Council (CNR), 87050 Mangone, Italy
| | - Simon Hammans
- Wessex Neurological Centre, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Gianina Ravenscroft
- Neurogenetic Diseases Group, Centre for Medical Research, QEII Medical Centre, University of Western Australia, Nedland, WA 6009, Australia
| | - Richard H Roxburgh
- Neurology Department, Auckland City Hospital, Auckland 1023, New Zealand and the Centre for Brain Research, University of Auckland, Auckland 1142, New Zealand
| | | | - Bianca Rugginini
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Elena Abati
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
- Department of Pathophysiology and Transplantation, University of Milan, 20122, Milan, Italy
| | - Arianna Manini
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
- Department of Pathophysiology and Transplantation, University of Milan, 20122, Milan, Italy
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, 20145 Milan, Italy
| | - Ilaria Quartesan
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Arianna Ghia
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Adolfo Lòpez de Munaìn
- Neurology Department, Donostia University Hospital, University of the Basque Country-Osakidetza-CIBERNED-Biodonostia, 20014 Donostia-San Sebastián, Spain
| | - Fiore Manganelli
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Marina Kennerson
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2050, Australia
| | - Filippo Maria Santorelli
- IRCCS Stella Maris Foundation, Molecular Medicine for Neurodegenerative and Neuromuscular Disease Unit, 56128 Pisa, Italy
| | - Jon Infante
- University Hospital Marquès de Valdecilla-IDIVAL, University of Cantabria, 39008 Santander, Spain
| | - Wilson Marques
- Department of Neurology, School of Medicine of Ribeirão Preto, University of São Paulo, 2650 Ribeirão Preto, Brazil
| | - Manu Jokela
- Neuromuscular Research Center, Department of Neurology, Tampere University and University Hospital, 33520 Tampere, Finland
- Neurocenter, Department of Neurology, Clinical Neurosciences, Turku University Hospital and University of Turku, 20014 Turku, Finland
| | - Sinéad M Murphy
- Department of Neurology, Tallaght University Hospital, D24 NR0A, Dublin, Ireland
- Academic Unit of Neurology, Trinity College Dublin, D02 R590, Dublin, Ireland
| | - Paola Mandich
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Gian Maria Fabrizi
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Chiara Briani
- Department of Neurosciences, ERN Neuromuscular Unit, University of Padova, 35100 Padova, Italy
| | - David Gosal
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Greater Manchester M6 8HD, UK
| | - Davide Pareyson
- Fondazione IRCCS Istituto Neurologico Carlo Besta, 20126 Milan, Italy
| | | | - Ferran Prados
- Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, WC1 V 6LJ London, UK
- NMR Research Unit, Institute of Neurology, University College London (UCL), WC1N 3BG London, UK
- e-Health Centre, Universitat Oberta de Catalunya, 08018 Barcelona, Spain
| | - Tarek Yousry
- Neuroradiological Academic Unit, University College London Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Vikram Khurana
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - James Miller
- Department of Neurology, Royal Victoria Hospitals, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Queen Victoria Road, NE1 4LP Newcastle, UK
| | - Claire Troakes
- London Neurodegenerative Diseases Brain Bank, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, SE21 8EA London, UK
| | - Zane Jaunmuktane
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology, University College London, WC1N 3BG London, UK
| | - Paola Giunti
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Annette Hartmann
- Division of General Psychiatry, Medical University of Vienna, 1090 Vienna, Austria
| | - Nazli Basak
- Koç University, School of Medicine, Suna and İnan Kıraç Foundation, Neurodegeneration Research Laboratory (NDAL), Research Center for Translational Medicine, 34010 Istanbul, Turkey
| | - Matthis Synofzik
- Research Division "Translational Genomics of Neurodegenerative Diseases", Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, 72076 Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, 72076 Tübingen, Germany
| | - Tanya Stojkovic
- Nord/Est/Ile-de-France Neuromuscular Reference Center, Institute of Myology, Pitié-Salpêtrière Hospital, APHP, 75013 Paris, France
| | - Marios Hadjivassiliou
- Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Trust and University of Sheffield, S10 2JF Sheffield, UK
| | - Mary M Reilly
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Henry Houlden
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Andrea Cortese
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| |
Collapse
|
6
|
Selvadurai LP, Perlman SL, Ashizawa T, Wilmot GR, Onyike CU, Rosenthal LS, Shakkottai VG, Paulson HL, Subramony SH, Bushara KO, Kuo SH, Dietiker C, Geschwind MD, Nelson AB, Gomez CM, Opal P, Zesiewicz TA, Hawkins T, Yacoubian TA, Nopoulos PC, Sha SJ, Morrison PE, Figueroa KP, Pulst SM, Schmahmann JD. The Cerebellar Cognitive Affective/Schmahmann Syndrome Scale in Spinocerebellar Ataxias. Cerebellum 2024:10.1007/s12311-023-01651-0. [PMID: 38165578 DOI: 10.1007/s12311-023-01651-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 01/04/2024]
Abstract
The Cerebellar Cognitive Affective/Schmahmann Syndrome (CCAS) manifests as impaired executive control, linguistic processing, visual spatial function, and affect regulation. The CCAS has been described in the spinocerebellar ataxias (SCAs), but its prevalence is unknown. We analyzed results of the CCAS/Schmahmann Scale (CCAS-S), developed to detect and quantify CCAS, in two natural history studies of 309 individuals Symptomatic for SCA1, SCA2, SCA3, SCA6, SCA7, or SCA8, 26 individuals Pre-symptomatic for SCA1 or SCA3, and 37 Controls. We compared total raw scores, domain scores, and total fail scores between Symptomatic, Pre-symptomatic, and Control cohorts, and between SCA types. We calculated scale sensitivity and selectivity based on CCAS category designation among Symptomatic individuals and Controls, and correlated CCAS-S performance against age and education, and in Symptomatic patients, against genetic repeat length, onset age, disease duration, motor ataxia, depression, and fatigue. Definite CCAS was identified in 46% of the Symptomatic group. False positive rate among Controls was 5.4%. Symptomatic individuals had poorer global CCAS-S performance than Controls, accounting for age and education. The domains of semantic fluency, phonemic fluency, and category switching that tap executive function and linguistic processing consistently separated Symptomatic individuals from Controls. CCAS-S scores correlated most closely with motor ataxia. Controls were similar to Pre-symptomatic individuals whose nearness to symptom onset was unknown. The use of the CCAS-S identifies a high CCAS prevalence in a large cohort of SCA patients, underscoring the utility of the scale and the notion that the CCAS is the third cornerstone of clinical ataxiology.
Collapse
Affiliation(s)
- Louisa P Selvadurai
- Department of Neurology, Ataxia Center, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, Suite 2000, Boston, MA, 02114, USA
| | - Susan L Perlman
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Tetsuo Ashizawa
- Department of Neurology, Houston Methodist Research Institute, Houston, TX, USA
| | - George R Wilmot
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Chiadi U Onyike
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Liana S Rosenthal
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Vikram G Shakkottai
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Henry L Paulson
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Sub H Subramony
- Department of Neurology, McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, USA
| | - Khalaf O Bushara
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University, New York, NY, USA
| | - Cameron Dietiker
- Department of Neurology, University of California, San Francisco, CA, USA
| | | | - Alexandra B Nelson
- Department of Neurology, University of California, San Francisco, CA, USA
| | | | - Puneet Opal
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Theresa A Zesiewicz
- Department of Neurology, University of South Florida Ataxia Research Center, Tampa, FL, USA
| | - Trevor Hawkins
- Department of Neurology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Talene A Yacoubian
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peggy C Nopoulos
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Sharon J Sha
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Peter E Morrison
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Karla P Figueroa
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Stefan M Pulst
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Jeremy D Schmahmann
- Department of Neurology, Ataxia Center, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, Suite 2000, Boston, MA, 02114, USA.
| |
Collapse
|
7
|
Nicholas J, Amlang C, Lin CYR, Montaser-Kouhsari L, Desai N, Pan MK, Kuo SH, Shohamy D. The Role of the Cerebellum in Learning to Predict Reward: Evidence from Cerebellar Ataxia. Cerebellum 2023:10.1007/s12311-023-01633-2. [PMID: 38066397 DOI: 10.1007/s12311-023-01633-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 01/25/2024]
Abstract
Recent findings in animals have challenged the traditional view of the cerebellum solely as the site of motor control, suggesting that the cerebellum may also be important for learning to predict reward from trial-and-error feedback. Yet, evidence for the role of the cerebellum in reward learning in humans is lacking. Moreover, open questions remain about which specific aspects of reward learning the cerebellum may contribute to. Here we address this gap through an investigation of multiple forms of reward learning in individuals with cerebellum dysfunction, represented by cerebellar ataxia cases. Nineteen participants with cerebellar ataxia and 57 age- and sex-matched healthy controls completed two separate tasks that required learning about reward contingencies from trial-and-error. To probe the selectivity of reward learning processes, the tasks differed in their underlying structure: while one task measured incremental reward learning ability alone, the other allowed participants to use an alternative learning strategy based on episodic memory alongside incremental reward learning. We found that individuals with cerebellar ataxia were profoundly impaired at reward learning from trial-and-error feedback on both tasks, but retained the ability to learn to predict reward based on episodic memory. These findings provide evidence from humans for a specific and necessary role for the cerebellum in incremental learning of reward associations based on reinforcement. More broadly, the findings suggest that alongside its role in motor learning, the cerebellum likely operates in concert with the basal ganglia to support reinforcement learning from reward.
Collapse
Affiliation(s)
- Jonathan Nicholas
- Department of Psychology, Columbia University, New York, NY, USA
- Zuckerman Mind Brain Behavior Institute, Columbia University, Quad 3D, 3227 Broadway, New York, NY, 10027, USA
| | - Christian Amlang
- Department of Neurology, Columbia University Medical Center, 650 W. 168th St, Rm 305, New York, NY, 10032, USA
- Initiative for Columbia Ataxia and Tremor, Columbia University Medical Center, New York, NY, USA
| | - Chi-Ying R Lin
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | | | - Natasha Desai
- Department of Neurology, Columbia University Medical Center, 650 W. 168th St, Rm 305, New York, NY, 10032, USA
- Initiative for Columbia Ataxia and Tremor, Columbia University Medical Center, New York, NY, USA
| | - Ming-Kai Pan
- Department of Medical Research, National Taiwan University Hospital, 100, Taipei, Taiwan
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, 100, Taipei, Taiwan
- Cerebellar Research Center, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University Medical Center, 650 W. 168th St, Rm 305, New York, NY, 10032, USA.
- Initiative for Columbia Ataxia and Tremor, Columbia University Medical Center, New York, NY, USA.
| | - Daphna Shohamy
- Department of Psychology, Columbia University, New York, NY, USA.
- Zuckerman Mind Brain Behavior Institute, Columbia University, Quad 3D, 3227 Broadway, New York, NY, 10027, USA.
- Kavli Institute for Brain Science, Columbia University, New York, NY, USA.
| |
Collapse
|
8
|
Martuscello RT, Sivaprakasam K, Hartstone W, Kuo SH, Konopka G, Louis ED, Faust PL. Gene Expression Analysis of Laser-Captured Purkinje Cells in the Essential Tremor Cerebellum. Cerebellum 2023; 22:1166-1181. [PMID: 36242761 PMCID: PMC10359949 DOI: 10.1007/s12311-022-01483-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 12/13/2022]
Abstract
Essential tremor (ET) is a common, progressive neurological disease characterized by an 8-12-Hz kinetic tremor. Despite its high prevalence, the patho-mechanisms of tremor in ET are not fully known. Through comprehensive studies in postmortem brains, we identified major morphological changes in the ET cerebellum that reflect cellular damage in Purkinje cells (PCs), suggesting that PC damage is central to ET pathogenesis. We previously performed a transcriptome analysis in ET cerebellar cortex, identifying candidate genes and several dysregulated pathways. To directly target PCs, we purified RNA from PCs isolated by laser capture microdissection and performed the first ever PC-specific RNA-sequencing analysis in ET versus controls. Frozen postmortem cerebellar cortex from 24 ETs and 16 controls underwent laser capture microdissection, obtaining ≥2000 PCs per sample. RNA transcriptome was analyzed via differential gene expression, principal component analysis (PCA), and gene set enrichment analyses (GSEA). We identified 36 differentially expressed genes, encompassing multiple cellular processes. Some ET (13/24) had greater dysregulation of these genes and segregated from most controls and remaining ETs in PCA. Characterization of genes/pathways enriched in this PCA and GSEA identified multiple pathway dysregulations in ET, including RNA processing/splicing, synapse organization/ion transport, and oxidative stress/inflammation. Furthermore, a different set of pathways characterized marked heterogeneity among ET patients. Our data indicate a range of possible mechanisms for the pathogenesis of ET. Significant heterogeneity among ET combined with dysregulation of multiple cellular processes supports the notion that ET is a family of disorders rather than one disease entity.
Collapse
Affiliation(s)
- Regina T Martuscello
- Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center and the New York Presbyterian Hospital, 630 W 168th Street, P&S 15-405, New York, NY, 10032, USA
| | - Karthigayini Sivaprakasam
- Peter O'Donnell Jr. Brain Institute, Department of Neuroscience, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, USA
| | - Whitney Hartstone
- Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center and the New York Presbyterian Hospital, 630 W 168th Street, P&S 15-405, New York, NY, 10032, USA
| | - Sheng-Han Kuo
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, 650 W 168th Street, BB302, New York, NY, USA
| | - Genevieve Konopka
- Peter O'Donnell Jr. Brain Institute, Department of Neuroscience, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, USA
| | - Elan D Louis
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Suite NL9.114, Dallas, TX, USA
| | - Phyllis L Faust
- Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center and the New York Presbyterian Hospital, 630 W 168th Street, P&S 15-405, New York, NY, 10032, USA.
| |
Collapse
|
9
|
Lowell ER, Borders JC, Perry SE, Dakin AE, Sevitz JS, Kuo SH, Troche MS. Sensorimotor Cough Dysfunction in Cerebellar Ataxias. Cerebellum 2023:10.1007/s12311-023-01635-0. [PMID: 38032397 DOI: 10.1007/s12311-023-01635-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/11/2023] [Indexed: 12/01/2023]
Abstract
Cerebellar ataxias are neurological conditions with a high prevalence of aspiration pneumonia and dysphagia. Recent research shows that sensorimotor cough dysfunction is associated with airway invasion and dysphagia in other neurological conditions and may increase the risk of pneumonia. Therefore, this study aimed to characterize sensorimotor cough function and its relationship with ataxia severity. Thirty-seven participants with cerebellar ataxia completed voluntary and/or reflex cough testing. Ataxia severity was assessed using the Scale for the Assessment and Rating of Ataxia (SARA). Linear multilevel models revealed voluntary cough peak expiratory flow rate (PEFR) estimates of 2.61 L/s and cough expired volume (CEV) estimates of 0.52 L. Reflex PEFR (1.82 L/s) and CEV (0.34 L) estimates were lower than voluntary PEFR and CEV estimates. Variability was higher for reflex PEFR (15.74% coefficient of variation [CoV]) than voluntary PEFR (12.13% CoV). 46% of participants generated at least two, two-cough responses following presentations of reflex cough stimuli. There was a small inverse relationship between ataxia severity and voluntary PEFR (β = -0.05, 95% CI: -0.09 - -0.01 L) and ataxia severity and voluntary CEV (β = -0.01, 95% CI: -0.02 - -0.004 L/s). Relationships between reflex cough motor outcomes (PEFR β = 0.03, 95% CI: -0.007-0.07 L/s; CEV β = 0.007, 95% CI: -0.004-0.02 L) and ataxia severity were not statistically robust. Results indicate that voluntary and reflex cough sensorimotor dysfunction is present in cerebellar ataxias and that increased severity of ataxia symptoms may impact voluntary cough function.
Collapse
Affiliation(s)
- Emilie R Lowell
- Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, 525 W 120th St, New York, NY, 10027, USA
| | - James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, 525 W 120th St, New York, NY, 10027, USA
| | - Sarah E Perry
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
- New Zealand Brain Research Institute, Christchurch, New Zealand
- University of Canterbury Rose Centre for Stroke Recovery & Research at St. George's Medical Centre, Christchurch, New Zealand
| | - Avery E Dakin
- Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, 525 W 120th St, New York, NY, 10027, USA
| | - Jordanna S Sevitz
- Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, 525 W 120th St, New York, NY, 10027, USA
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
- The Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, USA
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Teachers College, Columbia University, 525 W 120th St, New York, NY, 10027, USA.
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand.
| |
Collapse
|
10
|
Barbuto S, Lee S, Stein J, Kuo SH, Quinn L, Spinner M, Derovanessian T, Stern Y. Physical Activity and Fitness Levels of Individuals With Ataxia: A Cross-Sectional Study. Arch Phys Med Rehabil 2023; 104:1669-1675. [PMID: 37380120 PMCID: PMC10543624 DOI: 10.1016/j.apmr.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/06/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE To investigate physical activity levels of individuals with ataxia and correlate fitness to ataxia severity. DESIGN An observational study SETTING: An outpatient ataxia clinic in a large, tertiary, urban hospital in the US. PARTICIPANTS Individuals with cerebellar ataxia (N=42). INTERVENTION Not applicable. MAIN OUTCOME MEASURE Participants were classified as sedentary or physically active using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Maximal oxygen consumption (V̇o2max) as an indicator of fitness level was measured, and ataxia severity was determined by the Scale for the Assessment and Rating of Ataxia (SARA). Mixed effect models were used to correlate ataxia severity to fitness levels. RESULTS Most participants (28 out of 42) lived sedentary lifestyles, and these individuals had poor fitness levels (only 67.3% of their predicted measure). The main barriers to physical activity included lack of energy, lack of time, and fear of falling. There were no differences in age, sex, disease type, disease duration, ataxia severity, fatigue level, and medication use between sedentary and active groups. Measures of V̇o2max, maximal work, maximal heart rate, and anerobic threshold demonstrated statistically significant differences between groups whereas maximal respiratory rate and expired ventilation/carbon dioxide production were similar between groups. When adjusting for age, sex, functional mobility status, and disease duration, ataxia severity was inversely correlated with fitness level in the sedentary group. There was no relationship between ataxia severity and fitness level in the 14 individuals who were physically active. CONCLUSIONS Lower fitness levels were associated with more ataxia symptoms in the sedentary group. This relationship was not seen in individuals who were more active. Given the poor health outcomes associated with low fitness, physical activity should be encouraged in this population.
Collapse
Affiliation(s)
- Scott Barbuto
- Department of Physical Medicine and Rehabilitation, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY.
| | - Seonjoo Lee
- Department of Biostatistics, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY
| | - Joel Stein
- Department of Physical Medicine and Rehabilitation, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY; Department of Physical Medicine and Rehabilitation, Weill Cornell Medical College, New York, NY
| | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY
| | - Lori Quinn
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Michael Spinner
- Department of Neurology, Psychiatry, Sergievsky Center and Taub Institute, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY
| | - Therese Derovanessian
- Department of Physical Medicine and Rehabilitation, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY
| | - Yaakov Stern
- Department of Neurology, Psychiatry, Sergievsky Center and Taub Institute, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY
| |
Collapse
|
11
|
Yang WC, Wei MF, Huang CS, Kuo SH. Radiosensitizing Effects of CDK4/6 Inhibitors in Hormone Receptor-Positive and HER2-Negative Breast Cancer are through Downregulating DNA Repair Mechanism and NF-κB-Signaling Pathway. Int J Radiat Oncol Biol Phys 2023; 117:e272. [PMID: 37785028 DOI: 10.1016/j.ijrobp.2023.06.1240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) CDK4/6 inhibitors combined with endocrine therapy are demonstrated to prolong survival for hormone receptor (HR)-positive and HER2-negative advanced breast cancer. We sought to assess whether cyclin-dependent kinases 4 and 6 (CDK4/6) inhibitors can enhance the radiosensitivity and their underlying mechanisms in this subtype of breast cancer through both in vitro and in vivo approaches. MATERIALS/METHODS We used MCF-7 and T-47D (HR-positive and HER2-negative) breast cancer cell lines, and different doses of CDK4/6 inhibitors (ribociclib and palbociclib) and radiotherapy (RT) to assess the biological functions and mechanisms through in vitro study. The radiation enhancing effect was assessed by clonogenic assay, numbers of the DNA damage response-related molecules, γH2AX and 53BP1, were assessed by immunofluorescence. The p-ERK, c-Myc, and DNA-double strand break (DNA-DSB)-related molecules, p-DNA-PKcs, and p-ATM, were assessed by western blotting. We used NF-κB p65 Transcription Factor Assay Kit to evaluate the transcriptional activity of NF-κB. We evaluated the antitumor effect of combined RT (2 Gy every other day for total 6 Gy) and ribociclib through the MCF-7 orthotopic xenograft model. RESULTS The synergistic effects of combining RT with different concentrations of ribociclib and palbociclib pretreatment were demonstrated by colonogenic assay. We revealed that CDK4/6 inhibitors synergistically increased the numbers of RT-induced γH2AX and 53BP1, downregulated the expression of p-DNA-PKcs and p-ATM activated by RT, and diminished the expression of RT-triggering p-ERK expression, and NF-κB activation and its down-streaming gene, c-Myc. When compared with control, ribociclib, and RT group, combined ribociclib and RT significantly shrunk the tumor growth of MCF-7 cell xenograft tumors, and downregulated the immunohistochemical expression of p-ERK, p-NF-κB p65, and c-Myc than control group. CONCLUSION Our results demonstrated that combining CDK4/6 inhibitors enhanced the radiosensitivity in HR-positive and HER2-negative breast cancer cells, and conceivably radioenhancing mechanisms of CDK4/6 inhibitors are at least through lessening DNA-DSB repairing processes and weakening the activation of ERK signaling and NF-κB signaling by RT.
Collapse
Affiliation(s)
- W C Yang
- Department of Radiation Oncology, National Taiwan University Cancer Center, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - M F Wei
- Division of Radiation Oncology, Department of Oncology, National Taiwan University, Taipei, Taiwan
| | - C S Huang
- Departments of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - S H Kuo
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| |
Collapse
|
12
|
Abstract
The cerebellum plays an important role in movement disorders, specifically in symptoms of ataxia, tremor, and dystonia. Understanding the physiological signals of the cerebellum contributes to insights into the pathophysiology of these movement disorders and holds promise in advancing therapeutic development. Non-invasive techniques such as electroencephalogram and magnetoencephalogram can record neural signals with high temporal resolution at the millisecond level, which is uniquely suitable to interrogate cerebellar physiology. These techniques have recently been implemented to study cerebellar physiology in healthy subjects as well as individuals with movement disorders. In the present review, we focus on the current understanding of cerebellar physiology using these techniques to study movement disorders.
Collapse
Affiliation(s)
- Ami Kumar
- Department of Neurology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, 650 W 168thStreet, Room 305, New York, NY, 10032, USA
- Initiative for Columbia Ataxia and Tremor, Columbia University Irving Medical Center, New York, NY, USA
| | - Chih-Chun Lin
- Department of Neurology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, 650 W 168thStreet, Room 305, New York, NY, 10032, USA
- Initiative for Columbia Ataxia and Tremor, Columbia University Irving Medical Center, New York, NY, USA
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, 650 W 168thStreet, Room 305, New York, NY, 10032, USA.
- Initiative for Columbia Ataxia and Tremor, Columbia University Irving Medical Center, New York, NY, USA.
| | - Ming-Kai Pan
- Cerebellar Research Center, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, 64041, Taiwan.
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei, 10051, Taiwan.
- Department of Medical Research, National Taiwan University Hospital, Taipei, 10002, Taiwan.
- Institute of Biomedical Sciences, Academia Sinica, Taipei City, 11529, Taiwan.
| |
Collapse
|
13
|
Selvadurai LP, Perlman SL, Wilmot GR, Subramony SH, Gomez CM, Ashizawa T, Paulson HL, Onyike CU, Rosenthal LS, Sair HI, Kuo SH, Ratai EM, Zesiewicz TA, Bushara KO, Öz G, Dietiker C, Geschwind MD, Nelson AB, Opal P, Yacoubian TA, Nopoulos PC, Shakkottai VG, Figueroa KP, Pulst SM, Morrison PE, Schmahmann JD. The S-Factor, a New Measure of Disease Severity in Spinocerebellar Ataxia: Findings and Implications. Cerebellum 2023; 22:790-809. [PMID: 35962273 PMCID: PMC10363993 DOI: 10.1007/s12311-022-01424-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/25/2022] [Indexed: 06/15/2023]
Abstract
Spinocerebellar ataxias (SCAs) are progressive neurodegenerative disorders, but there is no metric that predicts disease severity over time. We hypothesized that by developing a new metric, the Severity Factor (S-Factor) using immutable disease parameters, it would be possible to capture disease severity independent of clinical rating scales. Extracting data from the CRC-SCA and READISCA natural history studies, we calculated the S-Factor for 438 participants with symptomatic SCA1, SCA2, SCA3, or SCA6, as follows: ((length of CAG repeat expansion - maximum normal repeat length) /maximum normal repeat length) × (current age - age at disease onset) × 10). Within each SCA type, the S-Factor at the first Scale for the Assessment and Rating of Ataxia (SARA) visit (baseline) was correlated against scores on SARA and other motor and cognitive assessments. In 281 participants with longitudinal data, the slope of the S-Factor over time was correlated against slopes of scores on SARA and other motor rating scales. At baseline, the S-Factor showed moderate-to-strong correlations with SARA and other motor rating scales at the group level, but not with cognitive performance. Longitudinally the S-Factor slope showed no consistent association with the slope of performance on motor scales. Approximately 30% of SARA slopes reflected a trend of non-progression in motor symptoms. The S-Factor is an observer-independent metric of disease burden in SCAs. It may be useful at the group level to compare cohorts at baseline in clinical studies. Derivation and examination of the S-factor highlighted challenges in the use of clinical rating scales in this population.
Collapse
Affiliation(s)
- Louisa P Selvadurai
- Ataxia Center, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Susan L Perlman
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
| | - George R Wilmot
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Sub H Subramony
- Department of Neurology, University of Florida College of Medicine, McKnight Brain Institute, Gainesville, FL, USA
| | | | - Tetsuo Ashizawa
- Department of Neurology, Houston Methodist Research Institute, Houston, TX, USA
| | - Henry L Paulson
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Chiadi U Onyike
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Liana S Rosenthal
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Haris I Sair
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University, New York, NY, USA
| | - Eva-Maria Ratai
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Theresa A Zesiewicz
- Department of Neurology, Ataxia Research Center, University of South Florida, Tampa, FL, USA
| | - Khalaf O Bushara
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Gülin Öz
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Cameron Dietiker
- Department of Neurology, University of California, San Francisco, CA, USA
| | | | - Alexandra B Nelson
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Puneet Opal
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Talene A Yacoubian
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Peggy C Nopoulos
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Vikram G Shakkottai
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Karla P Figueroa
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Stefan M Pulst
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Peter E Morrison
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Jeremy D Schmahmann
- Ataxia Center, Cognitive Behavioral Neurology Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
14
|
Martuscello RT, Chen ML, Reiken S, Sittenfeld LR, Ruff DS, Ni CL, Lin CC, Pan MK, Louis ED, Marks AR, Kuo SH, Faust PL. Defective cerebellar ryanodine receptor type 1 and endoplasmic reticulum calcium 'leak' in tremor pathophysiology. Acta Neuropathol 2023; 146:301-318. [PMID: 37335342 PMCID: PMC10350926 DOI: 10.1007/s00401-023-02602-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/06/2023] [Accepted: 06/14/2023] [Indexed: 06/21/2023]
Abstract
Essential Tremor (ET) is a prevalent neurological disease characterized by an 8-10 Hz action tremor. Molecular mechanisms of ET remain poorly understood. Clinical data suggest the importance of the cerebellum in disease pathophysiology, and pathological studies indicate Purkinje Cells (PCs) incur damage. Our recent cerebellar cortex and PC-specific transcriptome studies identified alterations in calcium (Ca2+) signaling pathways that included ryanodine receptor type 1 (RyR1) in ET. RyR1 is an intracellular Ca2+ release channel located on the Endoplasmic Reticulum (ER), and in cerebellum is predominantly expressed in PCs. Under stress conditions, RyR1 undergoes several post-translational modifications (protein kinase A [PKA] phosphorylation, oxidation, nitrosylation), coupled with depletion of the channel-stabilizing binding partner calstabin1, which collectively characterize a "leaky channel" biochemical signature. In this study, we found markedly increased PKA phosphorylation at the RyR1-S2844 site, increased RyR1 oxidation and nitrosylation, and calstabin1 depletion from the RyR1 complex in postmortem ET cerebellum. Decreased calstabin1-RyR1-binding affinity correlated with loss of PCs and climbing fiber-PC synapses in ET. This 'leaky' RyR1 signature was not seen in control or Parkinson's disease cerebellum. Microsomes from postmortem cerebellum demonstrated excessive ER Ca2+ leak in ET vs. controls, attenuated by channel stabilization. We further studied the role of RyR1 in tremor using a mouse model harboring a RyR1 point mutation that mimics constitutive site-specific PKA phosphorylation (RyR1-S2844D). RyR1-S2844D homozygous mice develop a 10 Hz action tremor and robust abnormal oscillatory activity in cerebellar physiological recordings. Intra-cerebellar microinfusion of RyR1 agonist or antagonist, respectively, increased or decreased tremor amplitude in RyR1-S2844D mice, supporting a direct role of cerebellar RyR1 leakiness for tremor generation. Treating RyR1-S2844D mice with a novel RyR1 channel-stabilizing compound, Rycal, effectively dampened cerebellar oscillatory activity, suppressed tremor, and normalized cerebellar RyR1-calstabin1 binding. These data collectively support that stress-associated ER Ca2+ leak via RyR1 may contribute to tremor pathophysiology.
Collapse
Affiliation(s)
- Regina T Martuscello
- Department of Pathology and Cell Biology, Columbia University Medical Center Vagelos College of Physicians and Surgeons and the New York Presbyterian Hospital, 630 W 168th Street, PH Stem 15-124, New York, NY, 10032, USA
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, USA
| | - Meng-Ling Chen
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, 650 W 168th Street, BB305, New York, NY, USA
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, USA
| | - Steven Reiken
- Department of Physiology and Cellular Biophysics, Columbia University Vagelos College of Physicians and Surgeons, 1150 St Nicholas Ave, New York, NY, USA
| | - Leah R Sittenfeld
- Department of Physiology and Cellular Biophysics, Columbia University Vagelos College of Physicians and Surgeons, 1150 St Nicholas Ave, New York, NY, USA
| | - David S Ruff
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, 650 W 168th Street, BB305, New York, NY, USA
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, USA
| | - Chun-Lun Ni
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, 650 W 168th Street, BB305, New York, NY, USA
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, USA
| | - Chih-Chun Lin
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, 650 W 168th Street, BB305, New York, NY, USA
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, USA
| | - Ming-Kai Pan
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, USA
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Elan D Louis
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, USA
| | - Andrew R Marks
- Department of Physiology and Cellular Biophysics, Columbia University Vagelos College of Physicians and Surgeons, 1150 St Nicholas Ave, New York, NY, USA
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, 650 W 168th Street, BB305, New York, NY, USA
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, USA
| | - Phyllis L Faust
- Department of Pathology and Cell Biology, Columbia University Medical Center Vagelos College of Physicians and Surgeons and the New York Presbyterian Hospital, 630 W 168th Street, PH Stem 15-124, New York, NY, 10032, USA.
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, USA.
| |
Collapse
|
15
|
Jardim LB, Hasan A, Kuo SH, Magaña JJ, França M, Marques W, Camejo C, Santana-da-Silva LC, Leão EE, Espíndola G, Canals F, Miranda M, Salvatierra I, Cornejo-Olivas M, Fernandez-Ruiz J, Braga-Neto P, Dávila-Ortiz de Montellano DJ, Flores-Lagunes LL, Dupré N, Brais B, Vargas FR, Godeiro C, Coutinho L, Teive HG, Kaufmann M, Saffie P, Furtado GV, Saraiva-Pereira ML, Barsottini O, Pedroso JL, Rodríguez-Labrada R, Velázquez-Pérez L, Gomez C. An Exploratory Survey on the Care for Ataxic Patients in the American Continents and the Caribbean. Cerebellum 2023; 22:708-718. [PMID: 35796998 PMCID: PMC10461795 DOI: 10.1007/s12311-022-01442-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
Little is known about access of rare disease carriers to health care. To increase this knowledge, the Pan American Hereditary Ataxia Network (PAHAN) conducted an exploratory survey about care for hereditary ataxias in American continents and the Caribbean. A questionnaire was sent to health professionals about the hereditary ataxias identified; access to care; and local teaching and research. The number of ataxics under current care per 100,000 inhabitants was subtracted from the expected overall prevalence of 6/100,000, to estimate the prevalence of uncovered ataxic patients. Local Human Development Indexes (HDI) were used to measure socio-economic factors. Twenty-six sites participated. Twelve sites had very high, 13 had high, and one site had medium HDI. Participants reported on 2239 and 602 patients with spinocerebellar ataxias and recessive forms under current care. The number of patients under current care per inhabitants varied between 0.14 and 12/100,000. The estimated prevalence of uncovered ataxic patients was inversely proportional to HDIs (rho = 0.665, p = 0.003). Access to diagnosis, pre-symptomatic tests, and rehabilitation were associated with HDIs. More and better molecular diagnostic tools, protocols and guidelines, and professional training for ataxia care were the top priorities common to all respondents. Evidence of inequalities was confirmed. Lower HDIs were associated with high potential numbers of uncovered ataxic subjects, and with lack of molecular diagnosis, pre-symptomatic testing, and rehabilitation. More and better diagnostic tools, guidelines, and professional training were priorities to all sites. PAHAN consortium might help with the last two tasks.
Collapse
Affiliation(s)
- Laura Bannach Jardim
- Serviço de Genética Médica e Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2400, 90035-003, Porto Alegre, Brazil.
- Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, 90035-003, Brazil.
| | - Ali Hasan
- Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, 90035-003, Brazil
| | - Sheng-Han Kuo
- Columbia University, 710 West 168th Street, New York, NY, 10032, USA
| | - Jonathan Javier Magaña
- Instituto Nacional de Rehabilitación - LGII, Calz México-Xochimilco 289, Coapa, Guadalupe Tlalpan, Tlalpan, 14389, Ciudad de México, CDMX, México
| | - Marcondes França
- Universidade Estadual de Campinas, Cidade Universitária Zeferino Vaz - Barão Geraldo, Campinas, SP, 13083-970, Brazil
| | - Wilson Marques
- Faculdade de Medicina, Universidade de São Paulo, R. Ten. Catão Roxo, 3900 - Vila Monte Alegre, Ribeirão Preto, SP, 14015-010, Brazil
| | | | - Luiz Carlos Santana-da-Silva
- Instituto de Ciências Biológicas da Universidade Federal do Pará, Av. Perimetral, 2-224 - Guamá, Belém, 66077-830, Brazil
| | - Emília Embiruçu Leão
- Singular Medicina de Precisão, Rua Ewerton Visco, 290 - Sala 1301 - Caminho das Árvores, Salvador, 41820-022, Brazil
| | - Gisele Espíndola
- Hospital Universitário Polydoro Ernani de São Thiago da Universidade Federal de Santa Catarina, R. Profa. Maria Flora Pausewang - Trindade, Florianópolis, 88036-800, Brazil
| | - Francisca Canals
- Clinica Alemana, Av Vitacura 5951, Vitacura, Santiago, Región Metropolitana, Chile
| | - Marcelo Miranda
- Fundacion Diagnosis, Antonio Varas 175 of 32, Providencia, Santiago, Chile
| | - Igor Salvatierra
- Hospital Materno Infantil, Clinica Los Andes, GR46+9V7, El Alto, Bolívia
| | - Mario Cornejo-Olivas
- Instituto Nacional de Ciencias Neurologicas, Jr. Ancash 1271, Cercado de Lima 15003, Lima, Peru
| | - Juan Fernandez-Ruiz
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autónoma de México, Circuito Interior de La Ciudad Universitaria, AV. Universidad 3000, 04510, Ciudad de México, México
| | - Pedro Braga-Neto
- Departamento de Medicina Clínica, Universidade Federal Do Ceará, Rua Pro. Costa Mendes, 1608 - Bloco Didático, 4° andar - Rodolfo Teófilo, Fortaleza, Brazil
| | | | - Luis Leonardo Flores-Lagunes
- Instituto Nacional de Medicina Genómica, Periférico Sur 4809, Arenal Tepepan, Tlalpan, 14610, Ciudad de México, Mexico
| | - Nicolas Dupré
- Department of Medicine, Faculty of Medicine, Université Laval, Ferdinand Vandry Pavillon, 1050 Av. de la Médecine, Quebec City, Quebec, G1V 0A6, Canada
| | - Bernard Brais
- Departments of Neurology and Neurosurgery and Human Genetics, Montreal Neurological Institute-Hospital, Faculty of Medicine, McGill University, University Street, Montreal, Quebec, 3801H3A 2B4, Canada
| | - Fernando Regla Vargas
- Laboratório de Epidemiologia de Malformações Congênitas, Fundação Oswaldo Cruz, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, 21040-360, Brazil
| | - Clécio Godeiro
- Universidade Federal do Rio Grande do Norte, Campus Universitário - Lagoa Nova, Natal, 59078-970, Brazil
| | - Léo Coutinho
- Hospital das Clínicas da Universidade Federal do Paraná, R. Gen. Carneiro, 181 - Alto da Glória, Curitiba, 80060-900, Brazil
| | - Helio G Teive
- Hospital das Clínicas da Universidade Federal do Paraná, R. Gen. Carneiro, 181 - Alto da Glória, Curitiba, 80060-900, Brazil
| | - Marcelo Kaufmann
- Neurogenetics Unit, Hospital Jose Ramos Mejia, Gral. Urquiza 609, C1221 ADC, Buenos Aires, Argentina
| | - Paula Saffie
- Centro de Estudios de Trastornos del Movimiento, Avenida José Joaquín Prieto Vial #7271, Santiago, Chile
| | - Gabriel Vasata Furtado
- Serviço de Genética Médica e Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2400, 90035-003, Porto Alegre, Brazil
| | - Maria Luiza Saraiva-Pereira
- Serviço de Genética Médica e Centros de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2400, 90035-003, Porto Alegre, Brazil
- Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2600-Prédio Anexo, Porto Alegre, 90035-003, Brazil
| | - Orlando Barsottini
- Universidade Federal do Estado de São Paulo, R. Napoleão de Barros, 715 - Vila Clementino, São Paulo, São Paulo, Brasil
| | - José Luiz Pedroso
- Universidade Federal do Estado de São Paulo, R. Napoleão de Barros, 715 - Vila Clementino, São Paulo, São Paulo, Brasil
| | - Roberto Rodríguez-Labrada
- Cuban Centre for Neurosciences, 190st number 19818 between 27th and 27th, 11600, Playa, Havana, Cuba
- Centro para la Investigación y Rehabilitación de las Ataxias Hereditarias, Libertad Street number 26, between 12th and 16th, 80100, Holguin, Cuba
| | - Luis Velázquez-Pérez
- Centro para la Investigación y Rehabilitación de las Ataxias Hereditarias, Libertad Street number 26, between 12th and 16th, 80100, Holguin, Cuba
- Cuban Academy of Sciences, Cuba St Number 460 Between Teniente Rey and Amargura. Habana Vieja, 10100, Havana, Cuba
| | | |
Collapse
|
16
|
Manto M, Serrao M, Filippo Castiglia S, Timmann D, Tzvi-Minker E, Pan MK, Kuo SH, Ugawa Y. Neurophysiology of cerebellar ataxias and gait disorders. Clin Neurophysiol Pract 2023; 8:143-160. [PMID: 37593693 PMCID: PMC10429746 DOI: 10.1016/j.cnp.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/19/2023] [Accepted: 07/11/2023] [Indexed: 08/19/2023] Open
Abstract
There are numerous forms of cerebellar disorders from sporadic to genetic diseases. The aim of this chapter is to provide an overview of the advances and emerging techniques during these last 2 decades in the neurophysiological tests useful in cerebellar patients for clinical and research purposes. Clinically, patients exhibit various combinations of a vestibulocerebellar syndrome, a cerebellar cognitive affective syndrome and a cerebellar motor syndrome which will be discussed throughout this chapter. Cerebellar patients show abnormal Bereitschaftpotentials (BPs) and mismatch negativity. Cerebellar EEG is now being applied in cerebellar disorders to unravel impaired electrophysiological patterns associated within disorders of the cerebellar cortex. Eyeblink conditioning is significantly impaired in cerebellar disorders: the ability to acquire conditioned eyeblink responses is reduced in hereditary ataxias, in cerebellar stroke and after tumor surgery of the cerebellum. Furthermore, impaired eyeblink conditioning is an early marker of cerebellar degenerative disease. General rules of motor control suggest that optimal strategies are needed to execute voluntary movements in the complex environment of daily life. A high degree of adaptability is required for learning procedures underlying motor control as sensorimotor adaptation is essential to perform accurate goal-directed movements. Cerebellar patients show impairments during online visuomotor adaptation tasks. Cerebellum-motor cortex inhibition (CBI) is a neurophysiological biomarker showing an inverse association between cerebellothalamocortical tract integrity and ataxia severity. Ataxic gait is characterized by increased step width, reduced ankle joint range of motion, increased gait variability, lack of intra-limb inter-joint and inter-segmental coordination, impaired foot ground placement and loss of trunk control. Taken together, these techniques provide a neurophysiological framework for a better appraisal of cerebellar disorders.
Collapse
Affiliation(s)
- Mario Manto
- Service des Neurosciences, Université de Mons, Mons, Belgium
- Service de Neurologie, CHU-Charleroi, Charleroi, Belgium
| | - Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, University of Rome Sapienza, Polo Pontino, Corso della Repubblica 79 04100, Latina, Italy
- Gait Analysis LAB Policlinico Italia, Via Del Campidano 6 00162, Rome, Italy
| | - Stefano Filippo Castiglia
- Department of Medical and Surgical Sciences and Biotechnologies, University of Rome Sapienza, Polo Pontino, Corso della Repubblica 79 04100, Latina, Italy
- Gait Analysis LAB Policlinico Italia, Via Del Campidano 6 00162, Rome, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, via Bassi, 21, 27100 Pavia, Italy
| | - Dagmar Timmann
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Elinor Tzvi-Minker
- Department of Neurology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
- Syte Institute, Hamburg, Germany
| | - Ming-Kai Pan
- Cerebellar Research Center, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin 64041, Taiwan
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei 10051, Taiwan
- Department of Medical Research, National Taiwan University Hospital, Taipei 10002, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei City 11529, Taiwan
- Initiative for Columbia Ataxia and Tremor, Columbia University Irving Medical Center, New York, NY, USA
| | - Sheng-Han Kuo
- Institute of Biomedical Sciences, Academia Sinica, Taipei City 11529, Taiwan
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, Fukushima Medical University, Fukushima, Japan
| |
Collapse
|
17
|
Fanning A, Kuo SH. Clinical Heterogeneity of Essential Tremor: Understanding Neural Substrates of Action Tremor Subtypes. Cerebellum 2023:10.1007/s12311-023-01551-3. [PMID: 37022657 PMCID: PMC10556200 DOI: 10.1007/s12311-023-01551-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/07/2023]
Abstract
Essential tremor (ET) is a common movement disorder affecting millions of people. Studies of ET patients and perturbations in animal models have provided a foundation for the neural networks involved in its pathophysiology. However, ET encompasses a wide variability of phenotypic expression, and this may be the consequence of dysfunction in distinct subcircuits in the brain. The cerebello-thalamo-cortical circuit is a common substrate for the multiple subtypes of action tremor. Within the cerebellum, three sets of cerebellar cortex-deep cerebellar nuclei connections are important for tremor. The lateral hemispheres and dentate nuclei may be involved in intention, postural and isometric tremor. The intermediate zone and interposed nuclei could be involved in intention tremor. The vermis and fastigial nuclei could be involved in head and proximal upper extremity tremor. Studying distinct cerebellar circuitry will provide important framework for understanding the clinical heterogeneity of ET.
Collapse
Affiliation(s)
- Alexander Fanning
- Department of Neurology, Columbia University, New York, NY, 10032, USA
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, 10032, USA
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University, New York, NY, 10032, USA.
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, 10032, USA.
| |
Collapse
|
18
|
Barbuto S, Kuo SH, Winterbottom L, Lee S, Stern Y, O'Dell M, Stein J. Home Aerobic Training for Cerebellar Degenerative Diseases: a Randomized Controlled Trial. Cerebellum 2023; 22:272-281. [PMID: 35303255 PMCID: PMC8932090 DOI: 10.1007/s12311-022-01394-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 11/30/2022]
Abstract
Balance training has shown some benefits in cerebellar ataxia whereas the effects of aerobic training are relatively unknown. To determine whether a phase III trial comparing home aerobic to balance training in ambulatory patients with cerebellar ataxia is warranted, we conducted a single-center, assessor-blinded, randomized controlled trial. Nineteen subjects were randomized to aerobic training and 17 subjects to balance training. The primary outcome was improvement in ataxia as measured by the Scale for the Assessment and Rating of Ataxia (SARA). Secondary outcomes included safety, training adherence, and balance improvements. There were no differences between groups at baseline. Thirty-one participants completed the trial, and there were no training-related serious adverse events. Compliance to training was over 70%. There was a mean improvement in ataxia symptoms of 1.9 SARA points (SD 1.62) in the aerobic group compared to an improvement of 0.6 points (SD 1.34) in the balance group. Although two measures of balance were equivocal between groups, one measure of balance showed greater improvement with balance training compared to aerobic training. In conclusion, this 6-month trial comparing home aerobic versus balance training in cerebellar ataxia had excellent retention and adherence to training. There were no serious adverse events, and training was not interrupted by minor adverse events like falls or back pain. There was a significant improvement in ataxia symptoms with home aerobic training compared to balance training, and a phase III trial is warranted. Clinical trial registration number: NCT03701776 on October 8, 2018.
Collapse
Affiliation(s)
- Scott Barbuto
- Department of Physical Medicine and Rehabilitation, College of Physicians and Surgeons, Columbia University Medical Center, Harkness Pavilion, 180 Fort Washington, New York, NY, 10032, USA.
| | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Lauren Winterbottom
- Department of Physical Medicine and Rehabilitation, College of Physicians and Surgeons, Columbia University Medical Center, Harkness Pavilion, 180 Fort Washington, New York, NY, 10032, USA
| | - Seonjoo Lee
- Department of Biostatistics, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Yaakov Stern
- Department of Neurology and Taub Institute, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Michael O'Dell
- Department of Physical Medicine and Rehabilitation, Weill Cornell Medical College, New York, NY, USA
| | - Joel Stein
- Department of Physical Medicine and Rehabilitation, College of Physicians and Surgeons, Columbia University Medical Center, Harkness Pavilion, 180 Fort Washington, New York, NY, 10032, USA
- Department of Physical Medicine and Rehabilitation, Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
19
|
Uebachs M, Wegner P, Schaaf S, Kugai S, Jacobi H, Kuo SH, Ashizawa T, Fluck J, Klockgether T, Faber J. SCAview: an Intuitive Visual Approach to the Integrative Analysis of Clinical Data in Spinocerebellar Ataxias. Cerebellum 2023:10.1007/s12311-023-01546-0. [PMID: 37002505 PMCID: PMC10544694 DOI: 10.1007/s12311-023-01546-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 04/03/2023]
Abstract
With SCAview, we present a prompt and comprehensive tool that enables scientists to browse large datasets of the most common spinocerebellar ataxias intuitively and without technical effort. Basic concept is a visualization of data, with a graphical handling and filtering to select and define subgroups and their comparison. Several plot types to visualize all data points resulting from the selected attributes are provided. The underlying synthetic cohort is based on clinical data from five different European and US longitudinal multicenter cohorts in spinocerebellar ataxia type 1, 2, 3, and 6 (SCA1, 2, 3, and 6) comprising > 1400 patients with overall > 5500 visits. First, we developed a common data model to integrate the clinical, demographic, and characterizing data of each source cohort. Second, the available datasets from each cohort were mapped onto the data model. Third, we created a synthetic cohort based on the cleaned dataset. With SCAview, we demonstrate the feasibility of mapping cohort data from different sources onto a common data model. The resulting browser-based visualization tool with a thoroughly graphical handling of the data offers researchers the unique possibility to visualize relationships and distributions of clinical data, to define subgroups and to further investigate them without any technical effort. Access to SCAview can be requested via the Ataxia Global Initiative and is free of charge.
Collapse
Affiliation(s)
- Mischa Uebachs
- Department of Neurology, University Hospital Bonn, Bonn, Germany
- DRK Kamillus Klinik, Asbach, Germany
| | - Philipp Wegner
- Fraunhofer Institute for Algorithms and Scientific Computing (SCAI), St. Augustin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Sebastian Schaaf
- Bioinformatics Group, Department of Computer Science, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Simon Kugai
- Fraunhofer Institute for Algorithms and Scientific Computing (SCAI), St. Augustin, Germany
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Heike Jacobi
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University, New York, NY, USA
| | - Tetsuo Ashizawa
- Department of Neurology, Houston Methodist Research Institute, Houston, TX, USA
| | - Juliane Fluck
- ZB Med, Information Centre for Life Sciences, Cologne, Germany
- Department of Geodesy and Geoinformation, University of Bonn, Bonn, Germany
| | - Thomas Klockgether
- Department of Neurology, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Jennifer Faber
- Department of Neurology, University Hospital Bonn, Bonn, Germany.
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.
| |
Collapse
|
20
|
Kuo SH. GABA A Receptor Subtype Specificity in Essential Tremor. Neurotherapeutics 2023; 20:372-374. [PMID: 36765025 PMCID: PMC10121954 DOI: 10.1007/s13311-023-01341-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2022] [Indexed: 02/12/2023] Open
Affiliation(s)
- Sheng-Han Kuo
- Department of Neurology, Columbia University Medical Center, New York, NY, USA.
- Initiative for Columbia Ataxia and Tremor, Columbia University Irving Medical Center, New York, NY, USA.
| |
Collapse
|
21
|
Ni CL, Lin YT, Lu LY, Wang JH, Liu WC, Kuo SH, Pan MK. Tracking motion kinematics and tremor with intrinsic oscillatory property of instrumental mechanics. Bioeng Transl Med 2023; 8:e10432. [PMID: 36925695 PMCID: PMC10013767 DOI: 10.1002/btm2.10432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 10/10/2022] [Indexed: 11/11/2022] Open
Abstract
Tracking kinematic details of motor behaviors is a foundation to study the neuronal mechanism and biology of motor control. However, most of the physiological motor behaviors and movement disorders, such as gait, balance, tremor, dystonia, and myoclonus, are highly dependent on the overall momentum of the whole-body movements. Therefore, tracking the targeted movement and overall momentum simultaneously is critical for motor control research, but it remains an unmet need. Here, we introduce the intrinsic oscillatory property (IOP), a fundamental mechanical principle of physics, as a method for motion tracking in a force plate. The overall kinetic energy of animal motions can be transformed into the oscillatory amplitudes at the designed IOP frequency of the force plate, while the target movement has its own frequency features and can be tracked simultaneously. Using action tremor as an example, we reported that force plate-based IOP approach has superior performance and reliability in detecting both tremor severity and tremor frequency, showing a lower level of coefficient of variation (CV) compared with video- and accelerometer-based motion tracking methods and their combination. Under the locomotor suppression effect of medications, therapeutic effects on tremor severity can still be quantified by dynamically adjusting the overall locomotor activity detected by IOP. We further validated IOP method in optogenetic-induced movements and natural movements, confirming that IOP can represent the intensity of general rhythmic and nonrhythmic movements, thus it can be generalized as a common approach to study kinematics.
Collapse
Affiliation(s)
- Chun-Lun Ni
- Department of Neurology Columbia University New York New York USA.,The Initiative for Columbia Ataxia and Tremor New York New York USA.,Department of Biochemistry and Molecular Biology Indiana University School of Medicine Indianapolis Indiana USA
| | - Yi-Ting Lin
- Molecular Imaging Center, National Taiwan University Taipei City Taiwan.,Department of Psychology National Taiwan University Taipei City Taiwan
| | - Liang-Yin Lu
- Molecular Imaging Center, National Taiwan University Taipei City Taiwan.,Institute of Biomedical Sciences, Academia Sinica Taipei City Taiwan
| | - Jia-Huei Wang
- Molecular Imaging Center, National Taiwan University Taipei City Taiwan.,Institute of Biomedical Sciences, Academia Sinica Taipei City Taiwan.,Department and Graduate Institute of Pharmacology National Taiwan University College of Medicine Taipei City Taiwan
| | - Wen-Chuan Liu
- Molecular Imaging Center, National Taiwan University Taipei City Taiwan.,Institute of Biomedical Sciences, Academia Sinica Taipei City Taiwan.,Department and Graduate Institute of Pharmacology National Taiwan University College of Medicine Taipei City Taiwan
| | - Sheng-Han Kuo
- Department of Neurology Columbia University New York New York USA.,The Initiative for Columbia Ataxia and Tremor New York New York USA
| | - Ming-Kai Pan
- Molecular Imaging Center, National Taiwan University Taipei City Taiwan.,Institute of Biomedical Sciences, Academia Sinica Taipei City Taiwan.,Department and Graduate Institute of Pharmacology National Taiwan University College of Medicine Taipei City Taiwan.,Department of Medical Research National Taiwan University Hospital Taipei City Taiwan.,Cerebellar Research Center National Taiwan University Hospital, Yun-Lin Branch Yun-Lin Taiwan
| |
Collapse
|
22
|
Louis ED, Martuscello RT, Gionco JT, Hartstone WG, Musacchio JB, Portenti M, McCreary M, Kuo SH, Vonsattel JPG, Faust PL. Histopathology of the cerebellar cortex in essential tremor and other neurodegenerative motor disorders: comparative analysis of 320 brains. Acta Neuropathol 2023; 145:265-283. [PMID: 36607423 PMCID: PMC10461794 DOI: 10.1007/s00401-022-02535-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/14/2022] [Accepted: 12/22/2022] [Indexed: 01/07/2023]
Abstract
In recent years, numerous morphologic changes have been identified in the essential tremor (ET) cerebellar cortex, distinguishing ET from control brains. These findings have not been fully contextualized within a broader degenerative disease spectrum, thus limiting their interpretability. Building off our prior study and now doubling the sample size, we conducted comparative analyses in a postmortem series of 320 brains on the severity and patterning of cerebellar cortex degenerative changes in ET (n = 100), other neurodegenerative disorders of the cerebellum [spinocerebellar ataxias (SCAs, n = 47, including 13 SCA3 and 34 SCA1, 2, 6, 7, 8, 14); Friedreich's ataxia (FA, n = 13); multiple system atrophy (MSA), n = 29], and other disorders that may involve the cerebellum [Parkinson's disease (PD), n = 62; dystonia, n = 19] versus controls (n = 50). We generated data on 37 quantitative morphologic metrics, grouped into 8 broad categories: Purkinje cell (PC) loss, heterotopic PCs, PC dendritic changes, PC axonal changes (torpedoes), PC axonal changes (other than torpedoes), PC axonal changes (torpedo-associated), basket cell axonal hypertrophy, and climbing fiber-PC synaptic changes. Principal component analysis of z scored raw data across all diagnoses (11,651 data items) revealed that diagnostic groups were not uniform with respect to pathology. Dystonia and PD each differed from controls in only 4/37 and 5/37 metrics, respectively, whereas ET differed in 21, FA in 10, SCA3 in 10, MSA in 21, and SCA1/2/6/7/8/14 in 27. Pathological changes were generally on the milder end of the degenerative spectrum in ET, FA and SCA3, and on the more severe end of that spectrum in SCA1/2/6/7/8/14. Comparative analyses across morphologic categories demonstrated differences in relative expression, defining distinctive patterns of changes in these groups. In summary, we present a robust and reproducible method that identifies somewhat distinctive signatures of degenerative changes in the cerebellar cortex that mark each of these disorders.
Collapse
Affiliation(s)
- Elan D Louis
- Department of Neurology, University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390-8813, USA.
| | - Regina T Martuscello
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, New York, NY, USA
| | - John T Gionco
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, New York, NY, USA
| | - Whitney G Hartstone
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, New York, NY, USA
| | - Jessica B Musacchio
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, New York, NY, USA
| | - Marisa Portenti
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, New York, NY, USA
| | - Morgan McCreary
- Department of Neurology, University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390-8813, USA
| | - Sheng-Han Kuo
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Jean-Paul G Vonsattel
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, New York, NY, USA
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Phyllis L Faust
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, New York, NY, USA
| |
Collapse
|
23
|
Lin CYR, Kuo SH. Ataxias: Hereditary, Acquired, and Reversible Etiologies. Semin Neurol 2023; 43:48-64. [PMID: 36828010 DOI: 10.1055/s-0043-1763511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
A variety of etiologies can cause cerebellar dysfunction, leading to ataxia symptoms. Therefore, the accurate diagnosis of the cause for cerebellar ataxia can be challenging. A step-wise investigation will reveal underlying causes, including nutritional, toxin, immune-mediated, genetic, and degenerative disorders. Recent advances in genetics have identified new genes for both autosomal dominant and autosomal recessive ataxias, and new therapies are on the horizon for targeting specific biological pathways. New diagnostic criteria for degenerative ataxias have been proposed, specifically for multiple system atrophy, which will have a broad impact on the future clinical research in ataxia. In this article, we aim to provide a review focus on symptoms, laboratory testing, neuroimaging, and genetic testing for the diagnosis of cerebellar ataxia causes, with a special emphasis on recent advances. Strategies for the management of cerebellar ataxia is also discussed.
Collapse
Affiliation(s)
- Chi-Ying R Lin
- Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, Texas.,Department of Neurology, Alzheimer's Disease and Memory Disorders Center, Baylor College of Medicine, Houston, Texas
| | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York.,Initiative for Columbia Ataxia and Tremor, Columbia University Irving Medical Center, New York, New York
| |
Collapse
|
24
|
Matthews LG, Puryear CB, Correia SS, Srinivasan S, Belfort GM, Pan MK, Kuo SH. T-type calcium channels as therapeutic targets in essential tremor and Parkinson's disease. Ann Clin Transl Neurol 2023; 10:462-483. [PMID: 36738196 PMCID: PMC10109288 DOI: 10.1002/acn3.51735] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 02/05/2023] Open
Abstract
Neuronal action potential firing patterns are key components of healthy brain function. Importantly, restoring dysregulated neuronal firing patterns has the potential to be a promising strategy in the development of novel therapeutics for disorders of the central nervous system. Here, we review the pathophysiology of essential tremor and Parkinson's disease, the two most common movement disorders, with a focus on mechanisms underlying the genesis of abnormal firing patterns in the implicated neural circuits. Aberrant burst firing of neurons in the cerebello-thalamo-cortical and basal ganglia-thalamo-cortical circuits contribute to the clinical symptoms of essential tremor and Parkinson's disease, respectively, and T-type calcium channels play a key role in regulating this activity in both the disorders. Accordingly, modulating T-type calcium channel activity has received attention as a potentially promising therapeutic approach to normalize abnormal burst firing in these diseases. In this review, we explore the evidence supporting the theory that T-type calcium channel blockers can ameliorate the pathophysiologic mechanisms underlying essential tremor and Parkinson's disease, furthering the case for clinical investigation of these compounds. We conclude with key considerations for future investigational efforts, providing a critical framework for the development of much needed agents capable of targeting the dysfunctional circuitry underlying movement disorders such as essential tremor, Parkinson's disease, and beyond.
Collapse
Affiliation(s)
| | - Corey B Puryear
- Praxis Precision Medicines, Boston, Massachusetts, 02110, USA
| | | | - Sharan Srinivasan
- Praxis Precision Medicines, Boston, Massachusetts, 02110, USA.,Department of Neurology, University of Michigan, Ann Arbor, Michigan, 48109, USA
| | | | - Ming-Kai Pan
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei, 10051, Taiwan.,Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, 10617, Taiwan.,Department of Medical Research, National Taiwan University Hospital, Taipei, 10002, Taiwan.,Cerebellar Research Center, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, 64041, Taiwan
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University, New York, New York, 10032, USA.,Initiative for Columbia Ataxia and Tremor, Columbia University, New York, New York, 10032, USA
| |
Collapse
|
25
|
Lai RY, Desai NA, Amlang CJ, Lin CYR, Chen TX, Minyetty MJ, Amokrane N, Kuo SH. Gambling associated risk-taking decision in cerebellar ataxia. Parkinsonism Relat Disord 2023; 107:105252. [PMID: 36577359 PMCID: PMC9905314 DOI: 10.1016/j.parkreldis.2022.105252] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/09/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION People with cerebellar ataxia (CA) can develop impulsive and compulsive behaviors that significantly affect their and their family's quality of life. To further assess the decision-making process associated with these behaviors, we used the Iowa Gambling Task (IGT) to study people with CA. METHODS Sixty individuals with CA and thirty age-matched controls were enrolled in the study to complete the IGT. No participants had a prior or comorbid neurologic or psychiatric disorder associated with impulsivity. IGT performance in each of the five 20-trial blocks was compared between groups and the progression of participants' performance was assessed with simple linear regression models. Subgroup analyses were performed with genetic and non-genetic CA cases. RESULTS CA cases obtained significantly lower IGT total scores than controls (-5.30 ± 37.53 vs. 21.30 ± 37.37, p = 0.004). In addition, those with CA made riskier decisions throughout the task compared to controls. Although both CA and controls learned to make decisions with more favorable outcomes over the course of completing the IGT, CA participants never matched the controls' performance. IGT performance did not correlate with ataxia severity or depressive symptoms. CONCLUSION The IGT may capture a unique behavioral symptom of CA. Future studies may help elucidate the mechanisms underlying impaired decision-making in CA and further the understanding of a broader spectrum of cerebellar cognitive affective syndrome.
Collapse
Affiliation(s)
- Ruo-Yah Lai
- Department of Neurology, Columbia University Medical Center, 710 W 168th St, New York, NY, 10032, USA; Initiative for Columbia Ataxia and Tremor, Columbia University Medical Center, 710 W 168th St, New York, NY, 10032, USA
| | - Natasha A Desai
- Department of Neurology, Columbia University Medical Center, 710 W 168th St, New York, NY, 10032, USA; Initiative for Columbia Ataxia and Tremor, Columbia University Medical Center, 710 W 168th St, New York, NY, 10032, USA
| | - Christian J Amlang
- Department of Neurology, Columbia University Medical Center, 710 W 168th St, New York, NY, 10032, USA; Initiative for Columbia Ataxia and Tremor, Columbia University Medical Center, 710 W 168th St, New York, NY, 10032, USA
| | - Chi-Ying R Lin
- Alzheimer's Disease and Parkinson's Disease Centers, Department of Neurology, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX, 77030, USA
| | - Tiffany X Chen
- Department of Neurology, Columbia University Medical Center, 710 W 168th St, New York, NY, 10032, USA; Initiative for Columbia Ataxia and Tremor, Columbia University Medical Center, 710 W 168th St, New York, NY, 10032, USA; Department of Biomedical Engineering, Whiting School of Engineering, Johns Hopkins University, 3400 N Charles St, Baltimore, MD, 21218, USA
| | - Michael J Minyetty
- Department of Neurology, Columbia University Medical Center, 710 W 168th St, New York, NY, 10032, USA; Initiative for Columbia Ataxia and Tremor, Columbia University Medical Center, 710 W 168th St, New York, NY, 10032, USA
| | - Nadia Amokrane
- Department of Neurology, Columbia University Medical Center, 710 W 168th St, New York, NY, 10032, USA; Initiative for Columbia Ataxia and Tremor, Columbia University Medical Center, 710 W 168th St, New York, NY, 10032, USA
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University Medical Center, 710 W 168th St, New York, NY, 10032, USA; Initiative for Columbia Ataxia and Tremor, Columbia University Medical Center, 710 W 168th St, New York, NY, 10032, USA.
| |
Collapse
|
26
|
Chou CY, Agin-Liebes J, Kuo SH. Emerging therapies and recent advances for Tourette syndrome. Heliyon 2023; 9:e12874. [PMID: 36691528 PMCID: PMC9860289 DOI: 10.1016/j.heliyon.2023.e12874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/27/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023] Open
Abstract
Tourette syndrome is the most prevalent hyperkinetic movement disorder in children and can be highly disabling. While the pathomechanism of Tourette syndrome remains largely obscure, recent studies have greatly improved our knowledge about this disease, providing a new perspective in our understanding of this condition. Advances in electrophysiology and neuroimaging have elucidated that there is a reduction in frontal cortical volume and reduction of long rage connectivity to the frontal lobe from other parts of the brain. Several genes have also been identified to be associated with Tourette syndrome. Treatment of Tourette syndrome requires a multidisciplinary approach which includes behavioral and pharmacological therapy. In severe cases surgical therapy with deep brain stimulation may be warranted, though the optimal location for stimulation is still being investigated. Studies on alternative therapies including traditional Chinese medicine and neuromodulation, such as transcranial magnetic stimulation have shown promising results, but still are being used in an experimental basis. Several new therapies have also recently been tested in clinical trials. This review provides an overview of the latest findings with regards to genetics and neuroimaging for Tourette syndrome as well as an update on advanced therapeutics.
Collapse
Affiliation(s)
- Chih-Yi Chou
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, USA
| | - Julian Agin-Liebes
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, USA
| | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, USA
- Corresponding author. 650 West 168th Street, Room 305, New York, NY, 10032, USA. Fax: +(212) 305 1304.
| |
Collapse
|
27
|
Lin CYR, Amokrane N, Chen S, Chen TX, Lai RY, Trinh P, Minyetty MJ, Emmerich H, Pan MK, Claassen DO, Kuo SH. Cerebellar impulsivity-compulsivity assessment scale. Ann Clin Transl Neurol 2023; 10:48-57. [PMID: 36401598 PMCID: PMC9852385 DOI: 10.1002/acn3.51698] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/23/2022] [Accepted: 10/27/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The cerebellum has been identified as the key brain region that modulates reward processing in animal models. Consistently, we recently found that people with cerebellar ataxia have impulsive and compulsive behaviors (ICBs), the main symptoms related to abnormal reward processing. Due to the lack of a validated scale to quantitatively measure ICBs in cerebellar disorders, we aim to develop and validate a new scale, Cerebellar Impulsivity-Compulsivity Assessment (CIA). METHODS We recruited 62 cerebellar ataxia cases, categorized into those with ICBs and those without. We developed a preliminary version of CIA, containing 17 questions. We studied the internal consistency, test-retest reliability, and inter-rater reliability to formulate the final version of CIA, which constitutes only 10 questions. The receiver operating characteristic curve (ROC) was generated to assess the sensitivity and specificity of CIA. RESULTS Cerebellar ataxia cases with ICBs have threefold higher total preliminary CIA scores than those without ICBs (12.06 ± 5.96 vs. 4.68 ± 3.50, p = 0.038). Cronbach's alpha revealed good internal consistency across all items (α > 0.70). By performing the test-retest reliability and inter-rater reliability on the preliminary version of CIA, we excluded seven questions (r < 0.70) and generated the final version of CIA. Based on the ROC, a score of 8.0 in CIA was chosen as the cut-off for ICBs in individuals with cerebellar ataxia with 81% sensitivity and 81% specificity. INTERPRETATION CIA is a novel tool to assess ICBs in cerebellar ataxia and broaden our understanding of the cerebellum-related cognitive and behavioral symptoms.
Collapse
Affiliation(s)
- Chi-Ying R Lin
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
- Alzheimer's Disease and Memory Disorders Center, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Nadia Amokrane
- Department of Neurology, Columbia University Medical Center, New York, New York, USA
- Initiative of Columbia Ataxia and Tremor, Columbia University Medical Center, New York, New York, USA
| | - Serena Chen
- Department of Neurology, Columbia University Medical Center, New York, New York, USA
- Initiative of Columbia Ataxia and Tremor, Columbia University Medical Center, New York, New York, USA
| | - Tiffany X Chen
- Department of Neurology, Columbia University Medical Center, New York, New York, USA
- Initiative of Columbia Ataxia and Tremor, Columbia University Medical Center, New York, New York, USA
- Department of Biomedical Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ruo-Yah Lai
- Department of Neurology, Columbia University Medical Center, New York, New York, USA
- Initiative of Columbia Ataxia and Tremor, Columbia University Medical Center, New York, New York, USA
| | - Paula Trinh
- Department of Neurology, Columbia University Medical Center, New York, New York, USA
- Initiative of Columbia Ataxia and Tremor, Columbia University Medical Center, New York, New York, USA
| | - Michael J Minyetty
- Department of Neurology, Columbia University Medical Center, New York, New York, USA
- Initiative of Columbia Ataxia and Tremor, Columbia University Medical Center, New York, New York, USA
| | - Haidyn Emmerich
- Department of Neurology, Columbia University Medical Center, New York, New York, USA
- Initiative of Columbia Ataxia and Tremor, Columbia University Medical Center, New York, New York, USA
| | - Ming-Kai Pan
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Daniel O Claassen
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University Medical Center, New York, New York, USA
- Initiative of Columbia Ataxia and Tremor, Columbia University Medical Center, New York, New York, USA
| |
Collapse
|
28
|
Kuo SH, Tasset I, Cuervo AM, Sulzer D. Misfolded GBA/β-glucocerebrosidase impairs ER-quality control by chaperone-mediated autophagy in Parkinson disease. Autophagy 2022; 18:3050-3052. [PMID: 35482760 PMCID: PMC9673922 DOI: 10.1080/15548627.2022.2071383] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Inhibition of chaperone-mediated autophagy (CMA), a selective type of lysosomal degradation for intracellular proteins, may contribute to pathogenesis in neurodegenerative diseases including Parkinson disease (PD). Pathogenic variants of PD-related proteins that reside in the cytosol, including SNCA/alpha-synuclein, LRRK2 (leucine rich repeat kinase 2), UCHL1 (ubiquitin Cterminal hydrolase 1) and VPS35 (VPS35 retromer complex component), exert inhibitory effects on CMA. Decreased CMA activity has also been reported in sporadic PD patients, consistent with an association between CMA inhibition and PD. We have now reported the first example of CMA dysfunction caused by a non-cytosolic PD-related protein, GBA/β-glucocerebrosidase, the most common genetic risk factor for PD, which uncovers a new role for CMA in endoplasmic reticulum (ER) quality control.
Collapse
Affiliation(s)
- Sheng-Han Kuo
- Department of Neurology, Columbia University, New York, NY, USA
| | - Inmaculada Tasset
- Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, New York, NY, USA,Institute for Aging Studies, Albert Einstein College of Medicine, Bronx, NY, USA,Department of Biochemistry and Molecular Biology, University of Córdoba, Córdoba, Spain
| | - Ana Maria Cuervo
- Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, New York, NY, USA,Institute for Aging Studies, Albert Einstein College of Medicine, Bronx, NY, USA,CONTACT Ana Maria Cuervo Institute for Aging Studies, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David Sulzer
- Department of Neurology, Columbia University, New York, NY, USA,Department of Psychiatry and Pharmacology, Columbia University, New York, NY, USA,Department of Molecular Therapeutics, New York State Psychiatric Institute, New York, NY, USA,David Sulzer Department of Psychiatry and Pharmacology, Coumbia Unvierstity, New York, NY, USA
| |
Collapse
|
29
|
Sevitz JS, Borders JC, Dakin AE, Kiefer BR, Alcalay RN, Kuo SH, Troche MS. Rehabilitation of Airway Protection in Individuals With Movement Disorders: A Telehealth Feasibility Study. Am J Speech Lang Pathol 2022; 31:2741-2758. [PMID: 36279509 PMCID: PMC9911128 DOI: 10.1044/2022_ajslp-22-00063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE Airway protective deficits (swallowing and cough) greatly reduce health and quality of life and are a pervasive consequence of neurodegenerative movement disorders. Expiratory muscle strength training (EMST) and cough skill training (CST) are two treatment approaches to improve airway protection; however, many patients are unable to access these treatments. Telehealth may improve access to care, but it remains unknown whether these treatments are feasible and efficacious via telehealth. This study aimed to determine the practical feasibility and preliminary treatment effect of EMST and CST via telehealth. METHOD Twenty participants with movement disorders completed 4 weeks of EMST and 2 weeks of CST, including two clinician-directed treatment sessions via telehealth and 3 days of home practice per week. Feasibility was calculated for each treatment. Practical feasibility was defined as completing treatment (EMST or CST) and obtaining the relevant outcome measures-a proxy of maximum expiratory pressure (pMEP) for EMST and peak expiratory flow rate (PEFR) for CST-within a 30-min session/period. Session factors that may have influenced feasibility were examined. Preliminary treatment effect was defined as changes in pMEP and PEFR. RESULTS Time taken to obtain pMEP and complete EMST was 17.48 min, and time taken to obtain PEFR and complete CST was 17.69 min. pMEP, single voluntary cough PEFR, and sequential voluntary cough PEFR increased from pre- to posttreatment. CONCLUSIONS Findings suggest that the delivery of EMST and CST is feasible via telehealth and yield improvements to pMEP and PEFR. This has important implications for expanding service delivery of airway protective interventions and reducing health care disparities in people with neurodegenerative movement disorders. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21357669.
Collapse
Affiliation(s)
- Jordanna S Sevitz
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Avery E Dakin
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Brianna R Kiefer
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Roy N Alcalay
- Department of Neurology, Columbia University Irving Medical Center, New York, NY
- Department of Neurology, Tel Aviv Sourasky Medical Center, Israel
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University Irving Medical Center, New York, NY
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
- Department of Neurology, Columbia University Irving Medical Center, New York, NY
| |
Collapse
|
30
|
Louis ED, Iglesias-Hernandez D, Hernandez NC, Flowers X, Kuo SH, Vonsattel JPG, Faust PL. Characterizing Lewy Pathology in 231 Essential Tremor Brains From the Essential Tremor Centralized Brain Repository. J Neuropathol Exp Neurol 2022; 81:796-806. [PMID: 35950950 PMCID: PMC9487643 DOI: 10.1093/jnen/nlac068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The Essential Tremor Centralized Brain Repository is the largest repository of prospectively collected essential tremor (ET) brains (n = 231). Hence, we are uniquely poised to address several questions: What proportion of ET cases has Lewy pathology (LP)? What is the nature of that pathology and how does it relate to other comorbidities? Each brain had a complete neuropathological assessment, including α-synuclein immunostaining. We created a 10-category classification scheme to fully encapsulate the patterns of LP observed. Four metrics of cerebellar pathology were also quantified. Mean age at death = 89.0 ± 6.4 years. Fifty-eight (25.1%) had LP and 46 (19.9%) had early to late stages of Parkinson disease (PD). LP was very heterogeneous. Of 58 cases with LP, 14 (24.1%) clinically developed possible PD or PD after a latency of 5 or more years. There was a similar degree of cerebellar pathology in ET cases both with and without LP. In summary, 1 in 4 ET cases had LP-a proportion that seems higher than expected based on studies among control populations. Heterogeneous LP likely reflects clinical associations between ET and PD, and ET with Alzheimer disease-type neuropathology. These data further our understanding of ET and its relatedness to other degenerative diseases.
Collapse
Affiliation(s)
- Elan D Louis
- From the Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
| | | | - Nora C Hernandez
- From the Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
| | - Xena Flowers
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, New York, USA
| | - Sheng-Han Kuo
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Jean Paul G Vonsattel
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, New York, USA
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, New York, New York, USA
| | - Phyllis L Faust
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center and the New York Presbyterian Hospital, New York, New York, USA
| |
Collapse
|
31
|
Radmard S, Zesiewicz TA, Kuo SH. Evaluation of Cerebellar Ataxic Patients. Neurol Clin 2022; 41:21-44. [DOI: 10.1016/j.ncl.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
32
|
Chen TX, Lin CYR, Aumann MA, Yan Y, Amokrane N, Desai NA, Kang H, Claassen DO, Kuo SH. Impulsivity Trait Profiles in Patients With Cerebellar Ataxia and Parkinson Disease. Neurology 2022; 99:e176-e186. [PMID: 35428731 PMCID: PMC9280994 DOI: 10.1212/wnl.0000000000200349] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/21/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Individuals with cerebellar ataxia (CA) can develop impulsive behavioral symptoms, often resulting in negative interpersonal consequences, detrimentally affecting their quality of life. Limited evidence exists concerning impulsivity in CA and its associated behavioral changes. We assessed impulsive traits in CA using the Barratt Impulsivity Scale (BIS-11) and compared them with those of Parkinson disease (PD) to investigate the differences in the impulsive trait profiles between CA and PD. METHODS We conducted a dual-center cross-sectional study with individuals with CA and PD enrolled through consecutive sampling from movement disorders clinics at Columbia University Medical Center and Vanderbilt University Medical Center, respectively. Age-matched controls were recruited at the respective institutions. Participants were excluded if they had prior or comorbid neurologic and psychiatric diseases known to be associated with impulsivity. All participants completed the BIS-11 questionnaire as a measure of impulsive traits. We used a general linear model and a least absolute shrinkage and selection operation regression to compare the total, subscale, and individual items of the BIS-11 scores between groups. Subgroup analyses were performed to isolate cerebellar contributions to impulsivity from potential effects of extracerebellar pathology and dopaminergic dysfunction or medications. RESULTS A total of 190 participants-90 age-matched controls, 50 participants with CA, and 50 with PD-completed the assessments. Persons with CA reported 9.7% higher BIS-11 scores than controls (p < 0.001), while persons with PD reported 24.9% higher scores than controls (p < 0.001). In CA, the most affected domain of impulsivity was nonplanning. In contrast, persons with PD noted greater impulsivity across the nonplanning, attentional, and motor domains. DISCUSSION Impulsivity in CA is uniquely driven by the nonplanning trait, unlike in PD. This suggests that the cerebellum and basal ganglia may differentially govern impulsive behaviors with the cerebellum contributing to the brain circuitry of impulsivity in a domain-specific manner.
Collapse
Affiliation(s)
- Tiffany X Chen
- From the Department of Neurology (T.X.C., N.A., N.A.D., S.-H.K.) and Initiative of Columbia Ataxia and Tremor (T.X.C., N.A., N.A.D., S.-H.K.), Columbia University Medical Center, New York, NY; Department of Biomedical Engineering (T.X.C.), Johns Hopkins University, Baltimore, MD; Department of Neurology (C.-Y.R.L.), Baylor College of Medicine, Houston, TX; Vanderbilt Brain Institute (M.A.A.), Department of Psychology, Vanderbilt University; and Departments of Neurology (M.A.A., D.O.C.) and Statistics (Y.Y., H.K.), Vanderbilt University Medical Center, Nashville, TN
| | - Chi-Ying R Lin
- From the Department of Neurology (T.X.C., N.A., N.A.D., S.-H.K.) and Initiative of Columbia Ataxia and Tremor (T.X.C., N.A., N.A.D., S.-H.K.), Columbia University Medical Center, New York, NY; Department of Biomedical Engineering (T.X.C.), Johns Hopkins University, Baltimore, MD; Department of Neurology (C.-Y.R.L.), Baylor College of Medicine, Houston, TX; Vanderbilt Brain Institute (M.A.A.), Department of Psychology, Vanderbilt University; and Departments of Neurology (M.A.A., D.O.C.) and Statistics (Y.Y., H.K.), Vanderbilt University Medical Center, Nashville, TN
| | - Megan A Aumann
- From the Department of Neurology (T.X.C., N.A., N.A.D., S.-H.K.) and Initiative of Columbia Ataxia and Tremor (T.X.C., N.A., N.A.D., S.-H.K.), Columbia University Medical Center, New York, NY; Department of Biomedical Engineering (T.X.C.), Johns Hopkins University, Baltimore, MD; Department of Neurology (C.-Y.R.L.), Baylor College of Medicine, Houston, TX; Vanderbilt Brain Institute (M.A.A.), Department of Psychology, Vanderbilt University; and Departments of Neurology (M.A.A., D.O.C.) and Statistics (Y.Y., H.K.), Vanderbilt University Medical Center, Nashville, TN
| | - Yan Yan
- From the Department of Neurology (T.X.C., N.A., N.A.D., S.-H.K.) and Initiative of Columbia Ataxia and Tremor (T.X.C., N.A., N.A.D., S.-H.K.), Columbia University Medical Center, New York, NY; Department of Biomedical Engineering (T.X.C.), Johns Hopkins University, Baltimore, MD; Department of Neurology (C.-Y.R.L.), Baylor College of Medicine, Houston, TX; Vanderbilt Brain Institute (M.A.A.), Department of Psychology, Vanderbilt University; and Departments of Neurology (M.A.A., D.O.C.) and Statistics (Y.Y., H.K.), Vanderbilt University Medical Center, Nashville, TN
| | - Nadia Amokrane
- From the Department of Neurology (T.X.C., N.A., N.A.D., S.-H.K.) and Initiative of Columbia Ataxia and Tremor (T.X.C., N.A., N.A.D., S.-H.K.), Columbia University Medical Center, New York, NY; Department of Biomedical Engineering (T.X.C.), Johns Hopkins University, Baltimore, MD; Department of Neurology (C.-Y.R.L.), Baylor College of Medicine, Houston, TX; Vanderbilt Brain Institute (M.A.A.), Department of Psychology, Vanderbilt University; and Departments of Neurology (M.A.A., D.O.C.) and Statistics (Y.Y., H.K.), Vanderbilt University Medical Center, Nashville, TN
| | - Natasha A Desai
- From the Department of Neurology (T.X.C., N.A., N.A.D., S.-H.K.) and Initiative of Columbia Ataxia and Tremor (T.X.C., N.A., N.A.D., S.-H.K.), Columbia University Medical Center, New York, NY; Department of Biomedical Engineering (T.X.C.), Johns Hopkins University, Baltimore, MD; Department of Neurology (C.-Y.R.L.), Baylor College of Medicine, Houston, TX; Vanderbilt Brain Institute (M.A.A.), Department of Psychology, Vanderbilt University; and Departments of Neurology (M.A.A., D.O.C.) and Statistics (Y.Y., H.K.), Vanderbilt University Medical Center, Nashville, TN
| | - Hakmook Kang
- From the Department of Neurology (T.X.C., N.A., N.A.D., S.-H.K.) and Initiative of Columbia Ataxia and Tremor (T.X.C., N.A., N.A.D., S.-H.K.), Columbia University Medical Center, New York, NY; Department of Biomedical Engineering (T.X.C.), Johns Hopkins University, Baltimore, MD; Department of Neurology (C.-Y.R.L.), Baylor College of Medicine, Houston, TX; Vanderbilt Brain Institute (M.A.A.), Department of Psychology, Vanderbilt University; and Departments of Neurology (M.A.A., D.O.C.) and Statistics (Y.Y., H.K.), Vanderbilt University Medical Center, Nashville, TN
| | - Daniel O Claassen
- From the Department of Neurology (T.X.C., N.A., N.A.D., S.-H.K.) and Initiative of Columbia Ataxia and Tremor (T.X.C., N.A., N.A.D., S.-H.K.), Columbia University Medical Center, New York, NY; Department of Biomedical Engineering (T.X.C.), Johns Hopkins University, Baltimore, MD; Department of Neurology (C.-Y.R.L.), Baylor College of Medicine, Houston, TX; Vanderbilt Brain Institute (M.A.A.), Department of Psychology, Vanderbilt University; and Departments of Neurology (M.A.A., D.O.C.) and Statistics (Y.Y., H.K.), Vanderbilt University Medical Center, Nashville, TN
| | - Sheng-Han Kuo
- From the Department of Neurology (T.X.C., N.A., N.A.D., S.-H.K.) and Initiative of Columbia Ataxia and Tremor (T.X.C., N.A., N.A.D., S.-H.K.), Columbia University Medical Center, New York, NY; Department of Biomedical Engineering (T.X.C.), Johns Hopkins University, Baltimore, MD; Department of Neurology (C.-Y.R.L.), Baylor College of Medicine, Houston, TX; Vanderbilt Brain Institute (M.A.A.), Department of Psychology, Vanderbilt University; and Departments of Neurology (M.A.A., D.O.C.) and Statistics (Y.Y., H.K.), Vanderbilt University Medical Center, Nashville, TN.
| |
Collapse
|
33
|
Kuo SH, Louis ED. The future of pharmacotherapies for essential tremor: Enhancing GABA neurotransmission or reducing neuronal hyperexcitability? Int Rev Neurobiol 2022; 163:311-315. [PMID: 36172063 PMCID: PMC9512121 DOI: 10.1016/s0074-7742(22)00061-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, United States
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, United States
| | - Elan D Louis
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| |
Collapse
|
34
|
Affiliation(s)
- Elan D Louis
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, United States
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, United States
| |
Collapse
|
35
|
Louis ED, Kuo SH. Essential tremor: Is this an electrical or a degenerative disorder? Or is it both? Int Rev Neurobiol 2022; 163:61-64. [PMID: 36172064 PMCID: PMC9512119 DOI: 10.1016/s0074-7742(22)00053-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Elan D Louis
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, United States
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, United States
| |
Collapse
|
36
|
Louis ED, Kuo SH. Essential tremor as a harbinger: What is the cognitive fallout of having essential tremor? Int Rev Neurobiol 2022; 163:189-193. [PMID: 36172065 PMCID: PMC9512122 DOI: 10.1016/s0074-7742(22)00057-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Elan D Louis
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, United States
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, United States
| |
Collapse
|
37
|
Kuo SH, Louis ED. How important is the inferior olive in essential tremor? An evolving story. Int Rev Neurobiol 2022; 163:129-132. [PMID: 36172066 PMCID: PMC9512123 DOI: 10.1016/s0074-7742(22)00055-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, United States
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, United States
| | - Elan D Louis
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| |
Collapse
|
38
|
Wong SB, Wang YM, Lin CC, Geng SK, Vanegas-Arroyave N, Pullman SL, Kuo SH, Pan MK. Cerebellar Oscillations in Familial and Sporadic Essential Tremor. Cerebellum 2022; 21:425-431. [PMID: 34341893 PMCID: PMC8970339 DOI: 10.1007/s12311-021-01309-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
Enhanced cerebellar oscillations have recently been identified in essential tremor (ET) patients as a key pathophysiological change. Since ET is considered a heterogeneous group of diseases, we investigated whether cerebellar oscillations differ in ET subtypes (familial vs. sporadic). This study aims to determine cerebellar physiology in familial and sporadic ET. Using surface electroencephalogram, we studied cerebellar physiology in 40 ET cases (n = 22 familial and n = 18 sporadic) and 20 age-matched controls. Both familial and sporadic ET cases had an increase in the intensity of cerebellar oscillations when compared to controls. Interestingly, cerebellar oscillations correlated with tremor severity in familial ET but not in sporadic ET. Our study demonstrated that ET cases have enhanced cerebellar oscillations, and the different relationships between cerebellar oscillations and tremor severity in familial and sporadic ET suggest diverse cerebellar pathophysiology.
Collapse
Affiliation(s)
- Shi-Bing Wong
- Department of Pediatrics, Taipei Tzu Chi General Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, 23142, Taiwan
- School of Medicine, Tzu Chi University, Hualien, 97071, Taiwan
| | - Yi-Mei Wang
- Cerebellar Research Center, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, 64041, Taipei, Taiwan
- Department of Education and Medical Research, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, 64041, Taipei, Taiwan
| | - Chih-Chun Lin
- Department of Neurology, Columbia University, New York, NY, 10032, USA
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, 10032, USA
| | - Scott Kun Geng
- Department of Computer Science, Columbia University, New York, NY, 10027, USA
| | | | - Seth L Pullman
- Department of Neurology, Columbia University, New York, NY, 10032, USA
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University, New York, NY, 10032, USA
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, 10032, USA
| | - Ming-Kai Pan
- Cerebellar Research Center, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, 64041, Taipei, Taiwan.
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei, 10617, Taiwan.
- Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, 10617, Taiwan.
- Department of Medical Research, National Taiwan University Hospital, Taipei, 10002, Taiwan.
- Institute of Biomedical Sciences, Academia Sinica, Taipei, 11529, Taiwan.
| |
Collapse
|
39
|
Iannuzzelli K, Shi R, Carter R, Huynh R, Morgan O, Kuo SH, Bang J, Mills KA, Baranano K, Zee DS, Moukheiber E, Roda R, Butala A, Marvel C, Joyce M, Li X, Wang J, Rosenthal LS. The association between educational attainment and SCA 3 age of onset and disease course. Parkinsonism Relat Disord 2022; 98:99-102. [PMID: 35635856 PMCID: PMC10498785 DOI: 10.1016/j.parkreldis.2022.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 02/15/2022] [Accepted: 02/27/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The number of trinucleotide CAG repeats is inversely correlated with the age at onset (AAO) of motor symptoms in individuals with Spinocerebellar Ataxia type 3 (SCA 3) and may be responsible for 50%-60% of the variability in AAO. Drawing from a social determinants of health model, we sought to determine if educational attainment further contributes to the AAO and motor symptom progression of SCA 3. METHODS We performed a retrospective chart review in which twenty individuals met criteria for inclusion and had been seen by an ataxia specialist at our hospital between January 2005 and July 2019. AAO of motor symptoms and Scale for Assessment and Rating of Ataxia (SARA) scores were used as primary outcome measures. RESULTS Using a linear regression, we found that having greater CAG repeat length and greater than 16 years of education results in an earlier AAO. The importance of the CAG repeat length on AAO, however, is greater amongst individuals with lower education. Using a linear mixed model evaluating SARA score over time with AAO, we found that less than 16 years of education is associated with faster progression of the disease. CONCLUSION In our group of SCA 3 patients, level of education correlated with both the AAO and SARA scores. Though our findings need to be confirmed with a larger cohort, our study suggests that level of education can have a strong influence on health outcomes in SCA 3 and possibly other groups of patients with ataxia.
Collapse
Affiliation(s)
| | - Rosa Shi
- Department of Arts and Sciences, Johns Hopkins University, United States
| | - Reece Carter
- Department of Arts and Sciences, Johns Hopkins University, United States
| | - Rachel Huynh
- Department of Medicine, Utah Health Sciences, United States
| | - Owen Morgan
- Department of Neurology, Johns Hopkins School of Medicine, United States
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University, United States; Initiative for Columbia Ataxia and Tremor, Columbia University, United States
| | - Jee Bang
- Department of Neurology, Johns Hopkins School of Medicine, United States
| | - Kelly A Mills
- Department of Neurology, Johns Hopkins School of Medicine, United States
| | - Kristin Baranano
- Department of Neurology, Johns Hopkins School of Medicine, United States
| | - David S Zee
- Department of Neurology, Johns Hopkins School of Medicine, United States
| | - Emile Moukheiber
- Department of Neurology, Johns Hopkins School of Medicine, United States
| | - Ricardo Roda
- Department of Neurology, Johns Hopkins School of Medicine, United States
| | - Ankur Butala
- Department of Neurology, Johns Hopkins School of Medicine, United States
| | - Cherie Marvel
- Department of Neurology, Johns Hopkins School of Medicine, United States
| | - Michelle Joyce
- Department of Neurology, Johns Hopkins School of Medicine, United States
| | - Ximin Li
- Johns Hopkins Bloomberg School of Public Health, United States
| | - Jiangxia Wang
- Johns Hopkins Bloomberg School of Public Health, United States
| | - Liana S Rosenthal
- Department of Neurology, Johns Hopkins School of Medicine, United States.
| |
Collapse
|
40
|
Kuo SH, Tasset I, Cheng MM, Diaz A, Pan MK, Lieberman OJ, Hutten SJ, Alcalay RN, Kim S, Ximénez-Embún P, Fan L, Kim D, Ko HS, Yacoubian T, Kanter E, Liu L, Tang G, Muñoz J, Sardi SP, Li A, Gan L, Cuervo AM, Sulzer D. Mutant glucocerebrosidase impairs α-synuclein degradation by blockade of chaperone-mediated autophagy. Sci Adv 2022; 8:eabm6393. [PMID: 35138901 DOI: 10.1126/sciadv.abm6393] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The most common genetic risk factors for Parkinson's disease (PD) are a set of heterozygous mutant (MT) alleles of the GBA1 gene that encodes β-glucocerebrosidase (GCase), an enzyme normally trafficked through the ER/Golgi apparatus to the lysosomal lumen. We found that half of the GCase in lysosomes from postmortem human GBA-PD brains was present on the lysosomal surface and that this mislocalization depends on a pentapeptide motif in GCase used to target cytosolic protein for degradation by chaperone-mediated autophagy (CMA). MT GCase at the lysosomal surface inhibits CMA, causing accumulation of CMA substrates including α-synuclein. Single-cell transcriptional analysis and proteomics of brains from GBA-PD patients confirmed reduced CMA activity and proteome changes comparable to those in CMA-deficient mouse brain. Loss of the MT GCase CMA motif rescued primary substantia nigra dopaminergic neurons from MT GCase-induced neuronal death. We conclude that MT GBA1 alleles block CMA function and produce α-synuclein accumulation.
Collapse
Affiliation(s)
- Sheng-Han Kuo
- Department of Neurology, Columbia University , New York, NY 10032, USA
| | - Inmaculada Tasset
- Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Institute for Aging Studies, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Biochemistry and Molecular Biology, Universidad de Cordoba, Cordoba, Spain
| | - Melody M Cheng
- Department of Neurology, Columbia University , New York, NY 10032, USA
| | - Antonio Diaz
- Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Institute for Aging Studies, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Ming-Kai Pan
- Department of Neurology, Columbia University , New York, NY 10032, USA
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Ori J Lieberman
- Department of Neurology, Columbia University , New York, NY 10032, USA
| | - Samantha J Hutten
- Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Institute for Aging Studies, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Roy N Alcalay
- Department of Neurology, Columbia University , New York, NY 10032, USA
| | - Sangjun Kim
- Department of Neurology, Johns Hopkins University, Baltimore, MD 21205, USA
- Neurodegeneration and Stem Cell Programs, Institute for Cell Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Pilar Ximénez-Embún
- Proteomics Unit, Spanish National Cancer Research Centre (CNIO), ProteoRed-ISCIII, Madrid, Spain
| | - Li Fan
- Helen and Robert Appel Alzheimer's Disease Research Institute, Weill Cornell Medicine, New York, NY 10065, USA
| | - Donghoon Kim
- Department of Neurology, Johns Hopkins University, Baltimore, MD 21205, USA
- Neurodegeneration and Stem Cell Programs, Institute for Cell Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Han Seok Ko
- Department of Neurology, Johns Hopkins University, Baltimore, MD 21205, USA
- Neurodegeneration and Stem Cell Programs, Institute for Cell Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Talene Yacoubian
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Ellen Kanter
- Departments of Psychiatry and Pharmacology, Columbia University , New York, NY 10032, USA
| | - Ling Liu
- Department of Neurology, Columbia University , New York, NY 10032, USA
| | - Guomei Tang
- Department of Neurology, Columbia University , New York, NY 10032, USA
| | - Javier Muñoz
- Proteomics Unit, Spanish National Cancer Research Centre (CNIO), ProteoRed-ISCIII, Madrid, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Ikerbasque, Basque Foundation for Science, Bilbao, Spain
| | | | - Aiqun Li
- Department of Neurology, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Li Gan
- Helen and Robert Appel Alzheimer's Disease Research Institute, Weill Cornell Medicine, New York, NY 10065, USA
| | - Ana Maria Cuervo
- Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Institute for Aging Studies, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - David Sulzer
- Department of Neurology, Columbia University , New York, NY 10032, USA
- Departments of Psychiatry and Pharmacology, Columbia University , New York, NY 10032, USA
- Department of Molecular Therapeutics, New York State Psychiatric Institute, New York, NY 10032, USA
| |
Collapse
|
41
|
Pan MK, Kuo SH. Essential tremor: Clinical perspectives and pathophysiology. J Neurol Sci 2022; 435:120198. [PMID: 35299120 PMCID: PMC10363990 DOI: 10.1016/j.jns.2022.120198] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/01/2021] [Accepted: 02/17/2022] [Indexed: 12/12/2022]
Abstract
Essential tremor (ET) is one of the most common neurological disorders and can be highly disabling. In recent years, studies on the clinical perspectives and pathophysiology have advanced our understanding of ET. Specifically, clinical heterogeneity of ET, with co-existence of tremor and other neurological features such as dystonia, ataxia, and cognitive dysfunction, has been identified. The cerebellum has been found to be the key brain region for tremor generation, and structural alterations of the cerebellum have been extensively studied in ET. Finally, four main ET pathophysiologies have been proposed: 1) environmental exposures to β-carboline alkaloids and the consequent olivocerebellar hyper-excitation, 2) cerebellar GABA deficiency, 3) climbing fiber synaptic pathology with related cerebellar oscillatory activity, 4) extra-cerebellar oscillatory activity. While these four theories are not mutually exclusive, they can represent distinctive ET subtypes, indicating multiple types of abnormal brain circuitry can lead to action tremor. This article is part of the Special Issue "Tremor" edited by Daniel D. Truong, Mark Hallett, and Aasef Shaikh.
Collapse
|
42
|
Abstract
INTRODUCTION Spinocerebellar ataxias (SCA) are a group of rare neurodegenerative diseases that dramatically affect the lives of affected individuals and their families. Despite having a clear understanding of SCA's etiology, there are no current symptomatic or neuroprotective treatments approved by the FDA. AREAS COVERED Research efforts have greatly expanded the possibilities for potential treatments, including both pharmacological and non-pharmacological interventions. Great attention is also being given to novel therapeutics based in gene therapy, neurostimulation, and molecular targeting. This review article will address the current advances in the treatment of SCA and what potential interventions are on the horizon. EXPERT OPINION SCA is a highly complex and multifaceted disease family with the majority of research emphasizing symptomatic pharmacologic therapies. As pre-clinical trials for SCA and clinical trials for other neurodegenerative conditions illuminate the efficacy of disease modifying therapies such as AAV-mediated gene therapy and ASOs, the potential for addressing SCA at the pre-symptomatic stage is increasingly promising.
Collapse
Affiliation(s)
- Shaila D Ghanekar
- University of South Florida (USF) Department of Neurology, USF Ataxia Research Center, Tampa, Florida, USA.,James A Haley Veteran's Hospital, Tampa, Florida, USA
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University, New York, New York, USA.,Initiative for Columbia Ataxia and Tremor, New York, New York, USA
| | - Joseph S Staffetti
- University of South Florida (USF) Department of Neurology, USF Ataxia Research Center, Tampa, Florida, USA.,James A Haley Veteran's Hospital, Tampa, Florida, USA
| | - Theresa A Zesiewicz
- University of South Florida (USF) Department of Neurology, USF Ataxia Research Center, Tampa, Florida, USA.,James A Haley Veteran's Hospital, Tampa, Florida, USA
| |
Collapse
|
43
|
Gionco JT, Hartstone WG, Martuscello RT, Kuo SH, Faust PL, Louis ED. Essential Tremor versus "ET-plus": A Detailed Postmortem Study of Cerebellar Pathology. Cerebellum 2021; 20:904-912. [PMID: 33768479 PMCID: PMC8972074 DOI: 10.1007/s12311-021-01263-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 12/17/2022]
Abstract
Essential tremor (ET) is among the most prevalent movement disorders, and by some accounts, the most common form of cerebellar degeneration. Over the past 15 years, we have carefully documented a large number of postmortem changes within the cerebellum; these cerebellar changes differ significantly between ET and controls. A recent Consensus Classification of tremor proposed that ET patients with other neurological signs aside from action tremor (e.g., parkinsonism, ataxia, cognitive changes, dystonia) should be segregated off as "ET-plus". This diagnostic concept has raised considerable controversy and its validity is not yet established. Indeed, "ET-plus" has not been distinguished from ET based on differences in genetics, pathology or prognosis. Here we determine whether ET cases differ from "ET-plus" cases in underlying pathological changes in the postmortem brain. We examined postmortem brains from 50 ET cases (24 ET and 26 ET-plus), using a set of 14 quantitative metrics of cerebellar pathology determined by histologic and immunohistochemical methods. These metrics reflect changes across the Purkinje cell (PC) body (PC counts, empty baskets, heterotopias), PC dendrites (swellings), PC axon (torpedoes and associated axonal changes), basket cell axonal hypertrophy and climbing fiber-PC dendrite synaptic changes. ET and ET-plus were similar with respect to 13 of 14 cerebellar pathologic metrics (p > 0.05). Only one metric, the linear density of thickened PC axon profiles, differed between these groups (ET = 0.529 ± 0.397, ET-plus = 0.777 ± 0.477, p = 0.013), although after correcting for multiple comparisons, there were no differences. If ET-plus were indeed a different entity, then the underlying pathological basis should be distinct from that of ET. This study demonstrated there were no pathological differences in cerebellar cortex between ET versus ET-plus cases. These data do not support the notion that ET and ET-plus represent distinct clinical-pathological entities.
Collapse
Affiliation(s)
- John T Gionco
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY, USA
| | - Whitney G Hartstone
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY, USA
| | - Regina T Martuscello
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY, USA
| | - Sheng-Han Kuo
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Phyllis L Faust
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY, USA
| | - Elan D Louis
- Department of Neurology, University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390-9020, USA.
| |
Collapse
|
44
|
Pandey S, Benito-León J, Kuo SH. Editorial: Tremor Syndromes: Current Concepts and Future Perspectives. Front Neurol 2021; 12:752463. [PMID: 34646231 PMCID: PMC8502893 DOI: 10.3389/fneur.2021.752463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sanjay Pandey
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi, India
| | - Julián Benito-León
- Department of Neurology, University Hospital, Madrid, Spain.,Center for Networked Biomedical Research on Neurodegenerative Diseases (CIBERNED), Madrid, Spain.,Department of Medicine, Complutense University, Madrid, Spain
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University, New York, NY, United States.,Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, United States
| |
Collapse
|
45
|
Seo BA, Kim D, Hwang H, Kim MS, Ma SX, Kwon SH, Kweon SH, Wang H, Yoo JM, Choi S, Kwon SH, Kang SU, Kam TI, Kim K, Karuppagounder SS, Kang BG, Lee S, Park H, Kim S, Yan W, Li YS, Kuo SH, Redding-Ochoa J, Pletnikova O, Troncoso JC, Lee G, Mao X, Dawson VL, Dawson TM, Ko HS. TRIP12 ubiquitination of glucocerebrosidase contributes to neurodegeneration in Parkinson's disease. Neuron 2021; 109:3758-3774.e11. [PMID: 34644545 DOI: 10.1016/j.neuron.2021.09.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 06/09/2021] [Accepted: 09/14/2021] [Indexed: 11/25/2022]
Abstract
Impairment in glucocerebrosidase (GCase) is strongly associated with the development of Parkinson's disease (PD), yet the regulators responsible for its impairment remain elusive. In this paper, we identify the E3 ligase Thyroid Hormone Receptor Interacting Protein 12 (TRIP12) as a key regulator of GCase. TRIP12 interacts with and ubiquitinates GCase at lysine 293 to control its degradation via ubiquitin proteasomal degradation. Ubiquitinated GCase by TRIP12 leads to its functional impairment through premature degradation and subsequent accumulation of α-synuclein. TRIP12 overexpression causes mitochondrial dysfunction, which is ameliorated by GCase overexpression. Further, conditional TRIP12 knockout in vitro and knockdown in vivo promotes the expression of GCase, which blocks α-synuclein preformed fibrils (α-syn PFFs)-provoked dopaminergic neurodegeneration. Moreover, TRIP12 accumulates in human PD brain and α-synuclein-based mouse models. The identification of TRIP12 as a regulator of GCase provides a new perspective on the molecular mechanisms underlying dysfunctional GCase-driven neurodegeneration in PD.
Collapse
Affiliation(s)
- Bo Am Seo
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Donghoon Kim
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Pharmacology, Peripheral Neuropathy Research Center (PNRC), Dong-A University College of Medicine, Busan, Republic of Korea.
| | - Heehong Hwang
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Min Seong Kim
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shi-Xun Ma
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Seung-Hwan Kwon
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sin Ho Kweon
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hu Wang
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Je Min Yoo
- Department of Chemistry, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, USA; Department of Chemistry, College of Natural Sciences, Seoul National University, Seoul, Republic of Korea
| | - Seulah Choi
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sang Ho Kwon
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sung-Ung Kang
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Diana Helis Henry Medical Research Foundation, New Orleans, LA, USA
| | - Tae-In Kam
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Adrienne Helis Malvin Medical Research Foundation, New Orleans, LA, USA
| | - Kwangsoo Kim
- Verna and Marrs McLean Department of Biochemistry and Molecular Biology, Baylor College of Medicine, Houston, TX, USA
| | - Senthilkumar S Karuppagounder
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bong Gu Kang
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Saebom Lee
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hyejin Park
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Diana Helis Henry Medical Research Foundation, New Orleans, LA, USA
| | - Sangjune Kim
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Biology, Chungbuk National University, Cheongju, Chungbuk 28644, Republic of Korea
| | - Wei Yan
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yong-Shi Li
- Department of Neurology, Columbia University, New York, NY, USA
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University, New York, NY, USA
| | - Javier Redding-Ochoa
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Olga Pletnikova
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Juan C Troncoso
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gabsang Lee
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Solomon H. Snyder Department of Neuroscience, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xiaobo Mao
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Valina L Dawson
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Physiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Solomon H. Snyder Department of Neuroscience, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Adrienne Helis Malvin Medical Research Foundation, New Orleans, LA, USA
| | - Ted M Dawson
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Solomon H. Snyder Department of Neuroscience, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Pharmacology and Molecular Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Adrienne Helis Malvin Medical Research Foundation, New Orleans, LA, USA; Diana Helis Henry Medical Research Foundation, New Orleans, LA, USA.
| | - Han Seok Ko
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Adrienne Helis Malvin Medical Research Foundation, New Orleans, LA, USA; Diana Helis Henry Medical Research Foundation, New Orleans, LA, USA.
| |
Collapse
|
46
|
Chen Y, Wu T, Li H, Li X, Li Q, Zhu X, Yu M, Kuo SH, Huang F, Wu YC. Corrigendum: Dl-3- n-Butylphthalide Exerts Dopaminergic Neuroprotection Through Inhibition of Neuroinflammation. Front Aging Neurosci 2021; 13:620015. [PMID: 34295236 PMCID: PMC8290916 DOI: 10.3389/fnagi.2021.620015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/13/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yajing Chen
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tingting Wu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Heng Li
- Department of Neurology, Jinan Central Hospital Affiliated to Shandong University, Jinan, China
| | - Xuan Li
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Li
- The State Key Laboratory of Medical Neurobiology, The Institutes of Brain Science and the Collaborative Innovation Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaoying Zhu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mei Yu
- The State Key Laboratory of Medical Neurobiology, The Institutes of Brain Science and the Collaborative Innovation Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Fang Huang
- The State Key Laboratory of Medical Neurobiology, The Institutes of Brain Science and the Collaborative Innovation Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yun-Cheng Wu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
47
|
Wu YC, Louis ED, Gionco J, Pan MK, Faust PL, Kuo SH. Increased Climbing Fiber Lateral Crossings on Purkinje Cell Dendrites in the Cerebellar Hemisphere in Essential Tremor. Mov Disord 2021; 36:1440-1445. [PMID: 33497495 PMCID: PMC8217183 DOI: 10.1002/mds.28502] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 12/21/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Climbing fibers (CFs) innervate Purkinje cells (PCs) with 1:1 relationship to ensure proper cerebellar function. Although CFs abnormally extend into the parallel fiber domain of PC dendrites in essential tremor (ET), the architecture of CFs in relation to PCs has yet to be investigated in detail. OBJECTIVE The aim of this work was to study the architecture of CFs in relation to PCs in ET. METHODS The number of PC somas and PC dendrites that a single CF crossed was quantified in the postmortem cerebellum of 15 ET cases and 15 control cases. RESULTS In ET, CFs crossed a greater number of PC somas and PC dendrites than in control cases, raising the possibility that there is abnormal CF wiring onto the PCs. Interestingly, the increase in CF-PC crossings positively correlated with tremor severity. CONCLUSIONS Patients with ET have increased CF crossings on PC dendrites. This abnormal architectural arrangement may contribute to synchronous brain activity and tremor. © 2021 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Yueh-Chi Wu
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- InitiatIve for Columbia Ataxia and Tremor, Columbia University, New York, New York, USA
| | - Elan D. Louis
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, Texas, USA
| | - John Gionco
- InitiatIve for Columbia Ataxia and Tremor, Columbia University, New York, New York, USA
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, New York, USA
| | - Ming-Kai Pan
- Department and Graduate Institute of Pharmacology, College of Medicine, National Taiwan University, Taipei, Taiwan
- Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, Taiwan
- Molecular Imaging Center, National Taiwan University, Taipei, Taiwan
| | - Phyllis L. Faust
- InitiatIve for Columbia Ataxia and Tremor, Columbia University, New York, New York, USA
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, New York, USA
| | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- InitiatIve for Columbia Ataxia and Tremor, Columbia University, New York, New York, USA
| |
Collapse
|
48
|
Brooker SM, Edamakanti CR, Akasha SM, Kuo SH, Opal P. Spinocerebellar ataxia clinical trials: opportunities and challenges. Ann Clin Transl Neurol 2021; 8:1543-1556. [PMID: 34019331 PMCID: PMC8283160 DOI: 10.1002/acn3.51370] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 12/14/2022] Open
Abstract
The spinocerebellar ataxias (SCAs) are a group of dominantly inherited diseases that share the defining feature of progressive cerebellar ataxia. The disease process, however, is not confined to the cerebellum; other areas of the brain, in particular, the brainstem, are also affected, resulting in a high burden of morbidity and mortality. Currently, there are no disease‐modifying treatments for the SCAs, but preclinical research has led to the development of therapeutic agents ripe for testing in patients. Unfortunately, due to the rarity of these diseases and their slow and variable progression, there are substantial hurdles to overcome in conducting clinical trials. While the epidemiological features of the SCAs are immutable, the feasibility of conducting clinical trials is being addressed through a combination of strategies. These include improvements in clinical outcome measures, the identification of imaging and fluid biomarkers, and innovations in clinical trial design. In this review, we highlight current challenges in initiating clinical trials for the SCAs and also discuss pathways for researchers and clinicians to mitigate these challenges and harness opportunities for clinical trial development.
Collapse
Affiliation(s)
- Sarah M Brooker
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Sara M Akasha
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University, New York, New York, USA.,Initiative for Columbia Ataxia and Tremor, Columbia University, New York, New York, USA
| | - Puneet Opal
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
49
|
Barbuto S, Martelli D, Isirame O, Lee N, Bishop L, Kuo SH, Agrawal S, Lee S, O’Dell M, Stein J. Phase I Single-Blinded Randomized Controlled Trial Comparing Balance and Aerobic Training in Degenerative Cerebellar Disease. PM R 2021; 13:364-371. [PMID: 32383352 PMCID: PMC7647960 DOI: 10.1002/pmrj.12401] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/01/2020] [Accepted: 05/01/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Primary deficits in individuals with cerebellar degeneration include ataxia, unstable gait, and incoordination. Balance training is routinely recommended to improve function whereas little is known regarding aerobic training. OBJECTIVE To determine the feasibility of conducting a randomized trial comparing balance and aerobic training in individuals with cerebellar degeneration. DESIGN Assessor blinded randomized control phase I trial. SETTING Assessments in medical center, home training. PARTICIPANTS Twenty participants with cerebellar degeneration were randomized to home balance or aerobic training. INTERVENTION Aerobic training consisted of 4 weeks of stationary bicycle training, five times per week for 30-minute sessions. Home balance training consisted of performing the same duration of easy, moderate, and/or hard exercises. OUTCOME MEASURES Scale for the Assessment and Rating of Ataxia (SARA), maximal oxygen consumption (VO2 max), Dynamic Gait Index, Timed Up and Go, gait speed. RESULTS All 20 participants completed assigned training with no major adverse events. Seven of each group attained target training duration, frequency, and intensity. Although both groups had significant improvements in ataxia severity, balance, and gait measures, there were greater improvements in individuals who performed aerobic training in ataxia severity and maximal oxygen consumption when compared to balance training. The effect size for these outcome measures was determined to be large, indicating a phase II trial comparing the benefits of aerobic and balance training was feasible and required 26 participants per group. Improvements in SARA score and VO2 max remained in the aerobic training group at 3 months posttraining, but these improvements were trending back to baseline. In contrast, all balance group measures for pretraining and 3 months posttraining were statistically similar. CONCLUSIONS A phase II trial comparing balance and aerobic training in individuals with cerebellar degeneration is feasible. Benefits trended back toward baseline after training stopped, although benefits of longer duration exercise programs still need to be determined.
Collapse
Affiliation(s)
- Scott Barbuto
- Department of Physical Medicine and Rehabilitation, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Dario Martelli
- Department of Engineering, Columbia University, New York, NY, USA
| | - Omofuma Isirame
- Department of Engineering, Columbia University, New York, NY, USA
| | - Nancy Lee
- Department of Physical Medicine and Rehabilitation, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Laurie Bishop
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Sunil Agrawal
- Department of Engineering, Columbia University, New York, NY, USA
| | - Seonjoo Lee
- Department of Biostatistics, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Michael O’Dell
- Department of Physical Medicine and Rehabilitation, Weill Cornell Medical College, New York, NY, USA
| | - Joel Stein
- Department of Physical Medicine and Rehabilitation, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
- Department of Physical Medicine and Rehabilitation, Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
50
|
Chen ML, Lin CC, Rosenthal LS, Opal P, Kuo SH. Rating scales and biomarkers for CAG-repeat spinocerebellar ataxias: Implications for therapy development. J Neurol Sci 2021; 424:117417. [PMID: 33836316 DOI: 10.1016/j.jns.2021.117417] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/26/2021] [Accepted: 03/23/2021] [Indexed: 01/18/2023]
Abstract
Spinocerebellar ataxias (SCAs) are a group of dominantly-inherited cerebellar ataxias, among which CAG expansion-related SCAs are most common. These diseases have very high penetrance with defined disease progression, and emerging therapies are being developed to provide either symptomatic or disease-modifying benefits. In clinical trial design, it is crucial to incorporate biomarkers to test target engagement or track disease progression in response to therapies, especially in rare diseases such as SCAs. In this article, we review the available rating scales and recent advances of biomarkers in CAG-repeat SCAs. We divided biomarkers into neuroimaging, body fluid, and physiological studies. Understanding the utility of each biomarker will facilitate the design of robust clinical trials to advance therapies for SCAs.
Collapse
Affiliation(s)
- Meng-Ling Chen
- Department of Neurology, Columbia University, New York, NY, USA; Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, USA
| | - Chih-Chun Lin
- Department of Neurology, Columbia University, New York, NY, USA; Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, USA
| | - Liana S Rosenthal
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Puneet Opal
- Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Cellular and Molecular Biology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University, New York, NY, USA; Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, USA.
| |
Collapse
|